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Salem MM, Maragkos GA, Gomez-Paz S, Ascanio LC, Ngo LH, Ogilvy CS, Thomas AJ, Moore JM. Trends of Ruptured and Unruptured Aneurysms Treatment in the United States in Post-ISAT Era: A National Inpatient Sample Analysis. J Am Heart Assoc 2021; 10:e016998. [PMID: 33559478 PMCID: PMC7955327 DOI: 10.1161/jaha.120.016998] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The ISAT (International Subarachnoid Aneurysm Trial) has generated a paradigm shift towards endovascular treatment for intracranial aneurysms but remains unclear if this has led to a true reduction in the risk for aneurysmal subarachnoid hemorrhage (aSAH). We sought to study the association between the treatment burden of unruptured and ruptured aneurysms in the post-ISAT era. Methods and Results Admissions data from the National Inpatient Sample (2004-2014) were extracted, including patients with a primary diagnosis of aSAH or unruptured intracranial aneurysms treated by clipping or coiling. Within each year, this combined group was randomly matched to non-aneurysmal control group, based on age, sex, and Elixhauser comorbidity index. Multinomial regression was performed to calculate the relative risk ratio of undergoing treatment for either ruptured or unruptured aneurysms in comparison with the reference control group, adjusted for time. After adjusting for National Inpatient Sample sampling effects, 243 754 patients with aneurysm were identified, 174 580 (71.6%) were women; mean age, 55.4±13.2 years. A total of 121 882 (50.01%) patients were treated for unruptured aneurysms, 79 627 (65.3%) endovascularly and 42 256 (34.7%) surgically. A total of 121 872 (49.99%) patients underwent procedures for aSAH, 68 921 (56.6%) endovascular, and 52 951 (43.5%) surgically. Multinomial regression revealed a significant year-to-year decrease in aSAH procedures compared with the control group of non-aneurysmal hospitalizations (relative risk ratio, 0.963 per year; P<0.001), while there was no statistical significance for unruptured aneurysms procedures (relative risk ratio, 1.012 per year; P=0.35). Conclusions With each passing year, there is a significant decrease in relative risk ratio of undergoing treatment for aSAH, concomitant with a stable annual risk of undergoing treatment for unruptured intracranial aneurysms.
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Affiliation(s)
- Mohamed M Salem
- Neurosurgery Service Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Georgios A Maragkos
- Neurosurgery Service Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Santiago Gomez-Paz
- Neurosurgery Service Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Luis C Ascanio
- Neurosurgery Service Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Long H Ngo
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Christopher S Ogilvy
- Neurosurgery Service Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Ajith J Thomas
- Neurosurgery Service Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Justin M Moore
- Neurosurgery Service Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
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Akamatsu Y, Gomez-Paz S, Moore JM, Ogilvy CS, Thomas AJ. Utility of Pipeline embolization device for emergency recanalization of a dissecting carotid tonsillar loop: illustrative cases. J Neurosurg Case Lessons 2021; 1:CASE2064. [PMID: 36131585 PMCID: PMC9628100 DOI: 10.3171/case2064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/28/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cervical arterial tortuosity is not uncommon in patients with spontaneous carotid artery dissections (CADs), but the tortuosity often precludes endovascular stent reconstruction. The authors report 2 cases of emergency recanalization of a carotid tonsillar loop dissection using a Pipeline embolization device (PED). OBSERVATIONS Two patients presented with symptomatic CAD involving tonsillar looping of the cervical internal carotid artery (ICA). Although the tonsillar loop prevented navigation of the carotid and peripheral stent delivery system, a PED was easily navigated and successfully deployed, resulting in successful recanalization of a looped ICA. LESSONS Emergency recanalization of a cervical CAD using a PED is a feasible alternative for treating a cervical CAD associated with tonsillar loops.
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Affiliation(s)
- Yosuke Akamatsu
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
- Department of Neurosurgery, Iwate Medical University, Yahaba, Japan
| | - Santiago Gomez-Paz
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Justin M. Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Christopher S. Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Ajith J. Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
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Salem MM, Ravindran K, Enriquez-Marulanda A, Ascanio LC, Jordan N, Gomez-Paz S, Foreman PM, Ogilvy CS, Thomas AJ, Moore JM. Pipeline Embolization Device Versus Stent-Assisted Coiling for Intracranial Aneurysm Treatment: A Retrospective Propensity Score-Matched Study. Neurosurgery 2021; 87:516-522. [PMID: 32133521 DOI: 10.1093/neuros/nyaa041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 01/11/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pipeline embolization device (PED; Medtronic) and stent-assisted coiling (SAC) are established modalities for treatment of intracranial aneurysms. OBJECTIVE To comparatively assess the efficacy of these techniques. METHODS We conducted a retrospective analysis of patients with aneurysms treated at our institution with either PED from 2013 to 2017 or SAC from 2009 to 2015. All large (>10 mm), ruptured, fusiform, anterior communicating artery, posterior circulation aneurysms, and patients with no available follow-up imaging were eliminated before running the propensity score matching (PSM). Patients were matched using nearest neighbor controlling for: age, gender, smoking, exact location, maximal diameter, and presence of multiple aneurysms. Total hospital costs for equipment and implants were calculated from procedure product and hospital billing records, and compared between the propensity-matched pairs. RESULTS Out of 165 patients harboring 202 aneurysms; 170 (84.2%) were treated with the PED, and 32 (15.8%) were treated using SAC. PSM resulted in 23 matched pairs; with significantly longer follow up in the SAC group (mean 29.8 vs 14.1 mo; P = .0002). Complete occlusion rates were not different (82.6 vs 87%; P = .68), with no difference between the groups for modified Rankin Scale on last clinical follow-up, procedural complications or retreatment rates. Average total costs calculated from the hospital records, including equipment and implants, were not different between propensity-score matched pairs (P = .48). CONCLUSION PED placement and SAC offer equally efficacious occlusion rates, functional outcomes, procedural complication rates, and cost profiles for small unruptured anterior circulation saccular aneurysms which do not involve the anterior communicating artery.
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Affiliation(s)
- Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Krishnan Ravindran
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Luis C Ascanio
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Noah Jordan
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Santiago Gomez-Paz
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Paul M Foreman
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Orlando Health, Neuroscience and Rehabilitation Institute, Orlando, Florida
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Maragkos GA, Filippidis AS, Chilamkurthy S, Salem MM, Tanamala S, Gomez-Paz S, Rao P, Moore JM, Papavassiliou E, Hackney D, Thomas AJ. Automated Lateral Ventricular and Cranial Vault Volume Measurements in 13,851 Patients Using Deep Learning Algorithms. World Neurosurg 2021; 148:e363-e373. [PMID: 33421645 DOI: 10.1016/j.wneu.2020.12.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND No large dataset-derived standard has been established for normal or pathologic human cerebral ventricular and cranial vault volumes. Automated volumetric measurements could be used to assist in diagnosis and follow-up of hydrocephalus or craniofacial syndromes. In this work, we use deep learning algorithms to measure ventricular and cranial vault volumes in a large dataset of head computed tomography (CT) scans. METHODS A cross-sectional dataset comprising 13,851 CT scans was used to deploy U-Net deep learning networks to segment and quantify lateral cerebral ventricular and cranial vault volumes in relation to age and sex. The models were validated against manual segmentations. Corresponding radiologic reports were annotated using a rule-based natural language processing framework to identify normal scans, cerebral atrophy, or hydrocephalus. RESULTS U-Net models had high fidelity to manual segmentations for lateral ventricular and cranial vault volume measurements (Dice index, 0.878 and 0.983, respectively). The natural language processing identified 6239 (44.7%) normal radiologic reports, 1827 (13.1%) with cerebral atrophy, and 1185 (8.5%) with hydrocephalus. Age-based and sex-based reference tables with medians, 25th and 75th percentiles for scans classified as normal, atrophy, and hydrocephalus were constructed. The median lateral ventricular volume in normal scans was significantly smaller compared with hydrocephalus (15.7 vs. 82.0 mL; P < 0.001). CONCLUSIONS This is the first study to measure lateral ventricular and cranial vault volumes in a large dataset, made possible with artificial intelligence. We provide a robust method to establish normal values for these volumes and a tool to report these on CT scans when evaluating for hydrocephalus.
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Affiliation(s)
- Georgios A Maragkos
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Aristotelis S Filippidis
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mohamed M Salem
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Santiago Gomez-Paz
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Justin M Moore
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Efstathios Papavassiliou
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - David Hackney
- Radiology Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ajith J Thomas
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Para A, Thelmo F, Rynecki ND, Zelman B, Gupta R, Coban D, Ayyaswami V, Prabhu AV, Ippolito JA, Agarwal N, Moore JM, Beebe KS. Evaluating the Readability of Online Patient Education Materials Related to Orthopedic Oncology. Orthopedics 2021; 44:38-42. [PMID: 33141234 DOI: 10.3928/01477447-20201012-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/20/2020] [Indexed: 02/03/2023]
Abstract
The internet is increasingly used to access patient education materials. The average American reading level has been found to be that of a 7th- to 8th-grade student, prompting the National Institutes of Health (NIH) and the American Medical Association (AMA) to advise that patient education materials be written between the 4th- to 6th-grade reading level. The purpose of this study was to evaluate the reading level of current patient education materials for the most common musculoskeletal oncological tumors. A Google search was performed with all location filters off to account for geographic variability for patient education materials related to 28 orthopedic primary or secondary tumors. All patient education articles from the first 10 website hits for each tumor type were analyzed. Patient education materials from these websites were evaluated using 8 validated readability scales. Patient resources were found to be written at an average grade level nearly double the NIH and AMA recommendation. Patient education materials for soft tissue chondromas were written at the highest level (14.8±1.9), whereas education materials for chordomas (10.1±1.0) most closely approached national recommendations, despite still being written at a readability level nearly 4 grade levels higher than has been recommended. The Flesch Reading Ease assessment provided a mean score of 46.5±7.7, corresponding with a "difficult to read" result. Current patient education materials regarding oncological musculoskeletal-related patient education materials are written significantly above the recommended reading level. Further modification of these resources is warranted to ensure adequate comprehension and informed decision making in the clinical setting. [Orthopedics. 2021;44(1):38-42.].
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Gomez-Paz S, Akamatsu Y, Salem MM, Enriquez-Marulanda A, Robinson TM, Ogilvy CS, Thomas AJ, Moore JM. Upfront middle meningeal artery embolization for treatment of chronic subdural hematomas in patients with or without midline shift. Interv Neuroradiol 2020; 27:571-576. [PMID: 33375866 DOI: 10.1177/1591019920982816] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES There is limited data on upfront middle meningeal artery (MMA) embolization in the context of significant midline shift (MLS) (greater than 5mm) for the treatment of chronic subdural hematomas (cSDH). This study reports the temporal changes following MMA embolization as an upfront treatment of cSDH in patients with or without MLS and either mild, no symptoms or mild and stable neurological deficits. METHODS A retrospective series of patients with a cSDH from a single institution in the United States between 2018-2020 was conducted. Eligible patients were treated with upfront MMA embolization. RESULTS 27 upfront MMA embolization procedures in 23 patients were included. Twelve patients had MLS of 5 millimeters or more (52%). The median maximal thickness at diagnosis was 18 mm [11-22]. The mean distance of MLS was 5 mm ±4. There were no procedural complications. The overall rescue surgery rate was 15%. A single rescue surgery secondary to an increase in hematoma thickness was required (4%). The temporal changes for both hematoma and MLS showed gradual improvement between 2 weeks and 4 weeks post-procedure. The average time-to-resolution of MLS was 46 days in patients with less than 5 mm MLS and 51 days in those with 5 mm or more. CONCLUSION Upfront MMA embolization for cSDH with a thickness up to 25 mm provides adequate symptom relief, stabilization and/or progressive resorption of the cSDH during follow-up in carefully selected asymptomatic or mildly symptomatic patients even in the presence of a MLS greater than 5 mm.
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Affiliation(s)
- Santiago Gomez-Paz
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Yosuke Akamatsu
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Timothy M Robinson
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Gomez-Paz S, Akamatsu Y, Salem MM, Enriquez-Marulanda A, Robinson T, Ogilvy CS, Thomas AJ, Moore JM. Effectiveness of Upfront Middle Meningeal Artery Embolization for Treatment of Chronic Subdural Hematomas in Patients With or Without Midline Shift. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lad M, Gupta R, Raman A, Gupta R, Para A, Moore JM. Trends in Reimbursements and Procedural Volume for Radiosurgery and Open Surgery in Neuro-oncology. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Akamatsu Y, Gomez-Paz S, Moore JM, Thomas AJ, Ogilvy CS. Endovascular Embolization of a Paracavernous Arteriovenous Fistula Through a Cortical Venous Access: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E604. [DOI: 10.1093/ons/opaa210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/30/2020] [Indexed: 11/12/2022] Open
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Gupta R, Lad M, Chandra A, Para A, Siddiqui E, Hardigan A, Thomas AJ, Ogilvy CS, Moore JM. An Assessment of Recent Trends in Endovascular and Open Vascular Neurosurgery Using Medicare Data. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gomez-Paz S, Ogilvy CS, Kicielinski KP, Salem MM, Akamatsu Y, Waqas M, Rai HH, Catapano J, Muram S, Elghareeb M, Siddiqui AH, Levy EI, Lawton MT, Mitha AP, Hoh BL, Polifka AJ, Fox WC, Moore JM, Thomas AJ. Cigarette Smoking and Risk of Intracranial Aneurysms in Middle-Aged Women. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Salem MM, Dmytriw AA, Lay SV, Renieri L, Sweid A, Moore JM, Jabbour P, Ogilvy CS, Limbucci N, Cognard C, Thomas AJ. Flow Diversion for Middle Cerebral Artery Bifurcation Aneurysms. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Salem MM, Maragkos GA, Gomez-Paz S, Ascanio LC, Ngo LH, Ogilvy CS, Thomas AJ, Moore JM. Trends of Ruptured and Unruptured Aneurysms Treatment in the US in Post-ISAT Era. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gomez-Paz S, Akamatsu Y, Mallick A, Jordan NJ, Salem MM, Thomas AJ, Ogilvy CS, Moore JM. Tortuosity of Target Carotid Artery Predicts Early Successful Revascularization and Functional Independence After Mechanical Thrombectomy. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Salem MM, Sweid A, Kuhn AL, Dmytriw AA, Gomez-Paz S, Maragkos GA, Waqas M, Parra-Farinas C, Salehani A, Adeeb N, Brouwer P, Pickett G, Yang VXD, Cognard C, Kan P, Limbucci N, Pereira VM, Harrigan MR, Puri AS, Levy EI, Moore JM, Ogilvy CS, Marotta TR, Jabbour P, Thomas AJ. Repeat Flow Diversion for Previously Failed Flow Diversion. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lad M, Gupta R, Para A, Gupta A, White MD, Agarwal N, Moore JM, Heary RF. An ACGME-Based Comparison of Neurosurgical and Orthopaedic Resident Training in Spine Surgery Via a Case Volume and Hours-Based Analysis. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abdalkader M, Samuelsen BT, Moore JM, Cervantes-Arslanian A, Ong CJ, Setty BN, Mian AZ, Nguyen TN. Ruptured Spinal Aneurysms: Diagnosis and Management Paradigms. World Neurosurg 2020; 146:e368-e377. [PMID: 33223127 DOI: 10.1016/j.wneu.2020.10.098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Spinal aneurysms (SA) are rare neurovascular pathologies with an unclear natural history and management strategy. We review the clinical and radiologic manifestations, management, and outcome of patients who presented with spinal subarachnoid hemorrhage (SAH) secondary to ruptured spinal aneurysms over a 10-year period. We provide a literature review about this condition and its management. METHODS All patients diagnosed with nontraumatic spinal SAH were collected from a single-center prospectively maintained database of patients with SAH between January 2010 and January 2020. Patients diagnosed with spinal aneurysms were reviewed. For each patient, demographic data, clinical presentation, imaging findings, management strategies, and outcomes are reviewed and discussed. RESULTS Between January 2010 and January 2020, ten patients were diagnosed with nontraumatic spinal SAH (3 patients presented with isolated spinal SAH and 7 patients with concomitant spinal and posterior fossa SAH). Among those, 4 patients were found to have a spinal aneurysm as the cause of SAH. The aneurysms were located in the cervical regions in 3 patients (75%) and at the thoracic level in 1 patient. Two aneurysms (50%) involved the anterior spinal artery, and 2 aneurysms (50%) involved a radiculomedullary artery. One aneurysm was a flow-related aneurysm of the anterior spinal artery in the setting of bilateral vertebral artery occlusion and was treated by surgical clipping with good outcome. Three aneurysms were idiopathic pseudoaneurysms with a negative diagnostic evaluation for secondary causes. These pseudoaneurysms were treated conservatively; 2 patients did well and 1 patient passed away from severe intracranial vasospasm. Two aneurysms resolved on diagnostic angiogram, and 1 aneurysm was absent on initial angiogram and appeared on follow-up diagnostic imaging 3 months later. CONCLUSIONS Spinal aneurysms are rare neurovascular pathologies that should be considered in the setting of spinal and/or posterior fossa subarachnoid hemorrhage. Conservative treatment may be a potential safe alternative to interventional treatment. Before the initiation of surgical or endovascular treatment, spinal angiography should be repeated because of the potential for spontaneous resolution.
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Affiliation(s)
- Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA.
| | - Brian T Samuelsen
- School of Medicine, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA
| | - Justin M Moore
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna Cervantes-Arslanian
- Department of Neurology, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA; Department of Neurosurgery, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA
| | - Charlene J Ong
- Department of Neurology, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA; Department of Neurosurgery, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA
| | - Bindu N Setty
- Department of Radiology, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA
| | - Asim Z Mian
- Department of Radiology, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA
| | - Thanh N Nguyen
- Department of Radiology, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA; Department of Neurology, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA; Department of Neurosurgery, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA
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Muram S, Eesa M, Belanger BL, Almekhlafi M, Goyal M, Morrish W, Wong JH, Gomez-Paz S, Akamatsu Y, Salem MM, Robinson TM, Moore JM, Thomas AJ, Ogilvy CS, Mitha AP. A Novel Parameter to Predict Supraclinoid Aneurysm Persistence After Flow Diversion with the Pipeline Embolization Device. World Neurosurg 2020; 145:e216-e223. [PMID: 33065343 DOI: 10.1016/j.wneu.2020.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Aneurysm recurrence after Pipeline Embolization Device (PED) placement can be caused by oversizing of the stent as well as poor wall apposition, both of which can lead to elongation. The objective of this study was to assess whether a novel parameter for measuring device elongation based on two-dimensional imaging could be predictive for persistent aneurysm filling after treatment with the PED. METHODS A retrospective cohort analysis was initially completed on 41 aneurysms from institution A, examining demographic, aneurysmal, and device measurements. Device measurements, including the ratio of the measured length to the nominal length (ML/NL) of the PED, were taken by reviewers blinded to the primary end point, which was aneurysm occlusion status on 6 month catheter angiogram. Findings were then externally validated against 30 aneurysms (supraclinoid only) from institution B. RESULTS Data from institution A showed 61% complete aneurysm occlusion at 6 months, and were lower for aneurysms in the supraclinoid region. For supraclinoid aneurysms alone, combined data from both institutions showed higher rates of nonocclusion with aneurysm neck size >4 mm (P = 0.008) and a trend toward significance in aneurysms with a branch vessel (P = 0.051). The mean ML/NL ratio was significantly larger in the nonoccluded group compared with the occluded group at both institution A (ratio, 1.37 versus 1.10; P < 0.001) and institution B (ratio, 1.36 vs. 1.11; P = 0.002). CONCLUSIONS Our data suggest that a novel parameter based on two-dimensional angiography may serve as a rapid technique to measure device elongation and predict occlusion of supraclinoid aneurysms after PED placement.
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Affiliation(s)
- Sandeep Muram
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Department of Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Muneer Eesa
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Brooke L Belanger
- Department of Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mohammed Almekhlafi
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Mayank Goyal
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - William Morrish
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - John H Wong
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Santiago Gomez-Paz
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Yosuke Akamatsu
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy M Robinson
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alim P Mitha
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, University of Calgary, Calgary, Alberta, Canada; Department of Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
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Ogilvy CS, Gomez-Paz S, Kicielinski KP, Salem MM, Akamatsu Y, Waqas M, Rai HH, Catapano JS, Muram S, Elghareeb M, Siddiqui AH, Levy EI, Lawton MT, Mitha AP, Hoh BL, Polifka A, Fox WC, Moore JM, Thomas AJ. Cigarette smoking and risk of intracranial aneurysms in middle-aged women. J Neurol Neurosurg Psychiatry 2020; 91:985-990. [PMID: 32723730 DOI: 10.1136/jnnp-2020-323753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/09/2020] [Accepted: 06/23/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE We previously reported a single-centre study demonstrating that smoking confers a six-fold increased risk for having an unruptured intracranial aneurysm (UIA) in women aged between 30 and 60 years and this risk was higher if the patient had chronic hypertension. There are no data with greater generalisability evaluating this association. We aimed to validate our previous findings in women from a multicentre study. METHODS A multicentre case-control study on women aged between 30 and 60 years, that had magnetic resonance angiography (MRA) during the period 2016-2018. Cases were those with an incidental UIA, and these were matched to controls based on age and ethnicity. A multivariable conditional logistic regression was conducted to evaluate smoking status and hypertension differences between cases and controls. RESULTS From 545 eligible patients, 113 aneurysm patients were matched to 113 controls. The most common reason for imaging was due to chronic headaches in 62.5% of cases and 44.3% of controls. A positive smoking history was encountered in 57.5% of cases and in 37.2% of controls. A multivariable analysis demonstrated a significant association between positive smoking history (OR 3.7, 95%CI 1.61 to 8.50), hypertension (OR 3.16, 95% CI 1.17 to 8.52) and both factors combined with a diagnosis of an incidental UIA (OR 6.9, 95% CI 2.49 to 19.24). CONCLUSIONS Women aged between 30 and 60 years with a positive smoking history have a four-fold increased risk for having an UIA, and a seven-fold increased risk if they have underlying chronic hypertension. These findings indicate that women aged between 30 and 60 years with a positive smoking history might benefit from a screening recommendation.
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Affiliation(s)
- Christopher S Ogilvy
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Santiago Gomez-Paz
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly P Kicielinski
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohamed M Salem
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Yosuke Akamatsu
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Muhammad Waqas
- Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, United States.,Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, United States
| | - Hamid Hussain Rai
- Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, United States.,Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, United States
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Sandeep Muram
- Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Mohammed Elghareeb
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
| | - Adnan H Siddiqui
- Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, United States.,Department of Neurosurgery and Radiology, Canon Strole and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, United States
| | - Elad I Levy
- Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, United States.,Department of Neurosurgery and Radiology, Canon Strole and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, United States
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Alim P Mitha
- Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Brian L Hoh
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
| | - Adam Polifka
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
| | - W Christopher Fox
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
| | - Justin M Moore
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ajith J Thomas
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Ascanio LC, Enriquez-Marulanda A, Maragkos GA, Salem MM, Alturki AY, Ravindran K, Fehnel CR, Hanafy KA, Ogilvy CS, Thomas AJ, Moore JM. In Reply: Effect of Blood Pressure Variability During the Acute Period of Subarachnoid Hemorrhage on Functional Outcomes. Neurosurgery 2020; 87:E430-E431. [PMID: 32511701 DOI: 10.1093/neuros/nyaa238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luis C Ascanio
- Neurosurgical Service Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts
| | | | - Georgios A Maragkos
- Neurosurgical Service Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts
| | - Mohamed M Salem
- Neurosurgical Service Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts
| | - Abdulrahman Y Alturki
- Neurosurgical Service Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts.,Department of Neurosurgery The National Neuroscience Institute King Fahad Medical City Riyadh, Saudi Arabia
| | - Krishnan Ravindran
- Neurosurgical Service Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts
| | - Corey R Fehnel
- Neurology Service Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts
| | - Khalid A Hanafy
- Neurology Service Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts
| | - Christopher S Ogilvy
- Neurosurgical Service Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts
| | - Ajith J Thomas
- Neurosurgical Service Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts
| | - Justin M Moore
- Neurosurgical Service Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts
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Dmytriw AA, Salem MM, Yang VXD, Krings T, Pereira VM, Moore JM, Thomas AJ. Endosaccular Flow Disruption: A New Frontier in Endovascular Aneurysm Management. Neurosurgery 2020; 86:170-181. [PMID: 30834934 PMCID: PMC7239377 DOI: 10.1093/neuros/nyz017] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/27/2019] [Indexed: 11/13/2022] Open
Abstract
Flow modification has caused a paradigm shift in the management of intracranial aneurysms. Since the FDA approval of the Pipeline Embolization Device (Medtronic, Dublin, Ireland) in 2011, it has grown to become the modality of choice for a range of carefully selected lesions, previously not amenable to conventional endovascular techniques. While the vast majority of flow-diverting stents operate from within the parent artery (ie, endoluminal stents), providing a scaffold for endothelial cells growth at the aneurysmal neck while inducing intra-aneurysmal thrombosis, a smaller subset of endosaccular flow disruptors act from within the lesions themselves. To date, these devices have been used mostly in Europe, while only utilized on a trial basis in North America. To the best of our knowledge, there has been no dedicated review of these devices. We therefore sought to present a comprehensive review of currently available endosaccular flow disruptors along with high-resolution schematics, presented with up-to-date available literature discussing their technical indications, procedural safety, and reported outcomes.
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Affiliation(s)
- Adam A Dmytriw
- Departments of Medical Imaging & Neurosurgery, University of Toronto, Toronto, Ontario, Canada.,Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Victor X D Yang
- Departments of Medical Imaging & Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Timo Krings
- Departments of Medical Imaging & Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Vitor M Pereira
- Departments of Medical Imaging & Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Dmytriw AA, Phan K, Salem MM, Adeeb N, Moore JM, Griessenauer CJ, Foreman PM, Shallwani H, Shakir H, Siddiqui AH, Levy EI, Davies JM, Harrigan MR, Thomas AJ, Ogilvy CS. The Pipeline Embolization Device: Changes in Practice and Reduction of Complications in the Treatment of Anterior Circulation Aneurysms in a Multicenter Cohort. Neurosurgery 2020; 86:266-271. [PMID: 30860254 DOI: 10.1093/neuros/nyz059] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/05/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Pipeline Embolization Device (PED; Medtronic, Dublin, Ireland) has become an important tool for the treatment of cerebral aneurysms. Since FDA approval, there are ongoing efforts to increase aneurysm occlusion rates and reduce the incidence of complications. OBJECTIVE To assess aneurysm occlusion and complication rates over time. METHODS Retrospective analysis of consecutive anterior circulation aneurysms treated with a single PED between 2011 and 2016 at 3 academic institutions in the US was performed. Factors contributing to changes in aneurysm occlusion and complication rates over time were identified and evaluated. RESULTS A total of 284 procedures were performed on 321 anterior circulation aneurysms in 284 patients. At a median follow-up of 13 mo (mean 18 mo), complete or near complete occlusion (>90%) was achieved in 85.9% of aneurysms. There was no significant change in aneurysm occlusion rate or procedure length over time. Thromboembolic complication occurred in 8.1% of procedures, and there was a trend toward decreased incidence from 16.3% in 2011/2012 to 3.3% in 2016 (P = .14). Hemorrhagic complications significantly decreased from 8.2% in 2011/2012 to 0 to 1.0% in 2014-2016 (P = .1). CONCLUSION We report a notable drop in the rate of hemorrhagic and to a lesser extent thromboembolic complications with increased experience with PED in a multicenter cohort. Multiple factors are believed to contribute to this drop, including the evolved interpretation of platelet function testing, the switching of clopidogrel nonresponders to ticagrelor, and the reduced use of adjunctive coiling.
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Affiliation(s)
- Adam A Dmytriw
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Kevin Phan
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Nimer Adeeb
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christoph J Griessenauer
- Department of Neurosurgery, Geisinger Health System, Geisinger School of Medicine, Danville, Pennsylvania
| | - Paul M Foreman
- Department of Neurosurgery, University of Alabama, Birmingham, Birmingham, Alabama
| | - Hussain Shallwani
- Department of Neurosurgery, State University of New York, Buffalo Buffalo, New York
| | - Hakeem Shakir
- Department of Neurosurgery, State University of New York, Buffalo Buffalo, New York
| | - Adnan H Siddiqui
- Department of Neurosurgery, State University of New York, Buffalo Buffalo, New York
| | - Elad I Levy
- Department of Neurosurgery, State University of New York, Buffalo Buffalo, New York
| | - Jason M Davies
- Department of Neurosurgery, State University of New York, Buffalo Buffalo, New York
| | - Mark R Harrigan
- Department of Neurosurgery, University of Alabama, Birmingham, Birmingham, Alabama
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Lamsam L, Bhambhvani HP, Thomas A, Ratliff JK, Moore JM. Aneurysmal subarachnoid hemorrhage in patients with migraine and tension headache: A cohort comparison study. J Clin Neurosci 2020; 79:90-94. [PMID: 33070926 DOI: 10.1016/j.jocn.2020.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/22/2020] [Accepted: 07/06/2020] [Indexed: 12/31/2022]
Abstract
Migraine headache is a common condition with an estimated lifetime prevalence of greater than 20%. While it is a well-established risk factor for cardiovascular disease and ischemic stroke, its association with subarachnoid hemorrhage is largely unexplored. We sought to compare the incidence of aneurysmal subarachnoid hemorrhage in a cohort of migraine patients with a cohort of patients with tension headache. A cohort comparison study utilizing the MarketScan insurance claims database compared patients diagnosed with migraine who were undergoing treatment with abortive or prophylactic pharmacotherapy (treatment cohort) and patients diagnosed with tension headache who had never been diagnosed with a migraine and who were naïve to migraine pharmacotherapy (control cohort). Patients with major pre-existing risk factors for aSAH were excluded from the study, and minor risk factors such as smoking status and hypertension were accounted for using coarsened exact matching (CEM) and subsequent cox proportional-hazards (CPH) regression. More than 679,000 patients (~125,000 treatment and ~ 550,000 control) with an average follow-up of more than three years were analyzed for aneurysmal subarachnoid hemorrhage. CPH regression on matched data showed that treated migraine patients had a significantly lower hazard of aneurysmal subarachnoid hemorrhage compared with tension headache patients (HR = 0.40, 95% CI: 0.19 - 0.86, p = 0.02). This large cohort comparison study, analyzing more than 679,000 patients, demonstrated that migraine patients undergoing pharmacologic treatment had a lower hazard of aneurysmal subarachnoid hemorrhage than patients diagnosed with tension headaches. Future work specifically focusing on migraine medications may identify the mechanisms underlying this association.
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Affiliation(s)
- Layton Lamsam
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Hriday P Bhambhvani
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA
| | - Ajith Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John K Ratliff
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA
| | - Justin M Moore
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA; Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Maragkos GA, Cordell S, Gomez-Paz S, Dodge LE, Salem MM, Ascanio LC, DiNobile D, Alturki AY, Moore JM, Ogilvy CS, Thomas AJ. Flow Diversion Endovascular Treatment Improves Headaches in Patients with Unruptured Intracranial Aneurysms. World Neurosurg 2020; 140:e140-e147. [DOI: 10.1016/j.wneu.2020.04.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
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Ogilvy CS, Gomez-Paz S, Kicielinski KP, Salem MM, Maragkos GA, Lee M, Vergara-Garcia D, Rojas R, Moore JM, Thomas AJ. Women With First-Hand Tobacco Smoke Exposure Have a Higher Likelihood of Having an Unruptured Intracranial Aneurysm Than Nonsmokers: A Nested Case-Control Study. Neurosurgery 2020; 87:1191-1198. [DOI: 10.1093/neuros/nyaa227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/28/2020] [Indexed: 12/25/2022] Open
Abstract
Abstract
BACKGROUND
The prevalence of unruptured intracranial aneurysms (UIA) in females who smoke cigarettes and the association between smoking and hypertension with purely incidental UIAs have been unexplored.
OBJECTIVE
To obtain the prevalence of UIA among females and to assess the relationship between smoking and hypertension with a diagnosis of incidental UIAs.
METHODS
A nested case-control study from a cohort of female patients aged between 30 and 60 yr with a brain magnetic resonance angiography (MRA) between 2016 and 2018. Incidental UIAs were compared to patients with normal MRAs. Smoking was characterized as never or former/current smokers. A logistic regression was used to evaluate the association between smoking, hypertension, or both, with a diagnosis of incidental UIAs.
RESULTS
A total of 1977 patients had a brain MRA between 2016 and 2018. From 1572 nonsmoker patients, we encountered 30 with an UIA (prevalence: 1.9%). There were 405 patients with a positive smoking history, and 77 patients harbored an UIA (prevalence: 19%). Of 64 aneurysm patients and 130 random controls eligible for the case control, aneurysm patients were more likely to have a positive smoking history and hypertension compared with healthy controls (60% vs 18%, P ≤ .001; 44% vs 14%, P ≤ .001). A multivariable analysis demonstrated a significant association between a smoking history, hypertension, or both factors with an incidental UIA (odds ratio [OR] 5.8 CI 1.22-11.70; OR 3.8 CI 2.31-14.78; OR 12.6 CI 4.38-36.26; respectively).
CONCLUSION
Females who smoke cigarettes have a higher prevalence of UIAs than the general population. Smoking confers a higher risk for having a silent UIA, aggravated by hypertension. This population is an ideal target for potential screening.
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Affiliation(s)
- Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Santiago Gomez-Paz
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kimberly P Kicielinski
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Georgios A Maragkos
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michelle Lee
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - David Vergara-Garcia
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Rafael Rojas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Adeeb N, Terrell DL, Whipple SG, Thakur JD, Griessenauer CJ, Adeeb A, Aslan A, Mamilly A, Mortazavi MM, Dossani RH, Guthikonda B, Ogilvy CS, Thomas AJ, Moore JM. The Reproducibility of Cerebrovascular Randomized Controlled Trials. World Neurosurg 2020; 140:e46-e52. [PMID: 32437984 DOI: 10.1016/j.wneu.2020.04.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Numerous randomized controlled trials (RCTs) relevant to the cerebrovascular field have been performed. The fragility index was recently developed to complement the P value and measure the robustness and reproducibility of clinical findings of RCTs. OBJECTIVE In this study, we evaluate the fragility index for key surgical and endovascular cerebrovascular RCTs and propose a novel RCT classification system based on the fragility index. METHODS Cerebrovascular RCTs reported between 2000 and 2018 were reviewed. Six key areas were specifically targeted in relation to stroke, carotid stenosis, cerebral aneurysms, and subarachnoid hemorrhage. The correlation between fragility index, number of patients lost to follow-up, and fragility quotient were evaluated to propose a classification system for the robustness of the studies. RESULTS A total of 20 RCTs that reported significant differences between both study groups in terms of the primary outcome were included. The median fragility index for the trials was 5.5. An additional 30 randomly selected RCTs were added to propose a classification system with high reliability. The difference between the number of patients lost to follow-up and fragility index inversely correlated with the fragility quotient and was used to divide the robustness of the RCTs into 3 classes reflecting the reproducibility of the trial. CONCLUSIONS Neurosurgeons and neurointerventionalists should exercise caution with interpreting the results of cerebrovascular RCTs, especially when the sample size and events numbers are small and there is a high number of patients who were lost to follow-up, as quantitatively identified using the proposed classification system.
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Affiliation(s)
- Nimer Adeeb
- Department of Neurosurgery, Ochsner LSU Medical Center, Louisiana State University, Shreveport, Louisiana, USA.
| | - Danielle L Terrell
- Department of Neurosurgery, Ochsner LSU Medical Center, Louisiana State University, Shreveport, Louisiana, USA
| | - Stephen Garrett Whipple
- Department of Neurosurgery, Ochsner LSU Medical Center, Louisiana State University, Shreveport, Louisiana, USA
| | - Jai Deep Thakur
- Department of Neurosurgery, Ochsner LSU Medical Center, Louisiana State University, Shreveport, Louisiana, USA
| | - Christoph J Griessenauer
- Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA; Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Abdallah Adeeb
- School of Medicine, An-Najah University, Nablus, Palestine
| | - Asala Aslan
- School of Medicine, An-Najah University, Nablus, Palestine
| | - Ahmed Mamilly
- Department of Radiology, Ochsner LSU Medical Center, Louisiana State University, Shreveport, Louisiana, USA
| | | | - Rimal H Dossani
- Department of Neurosurgery, Ochsner LSU Medical Center, Louisiana State University, Shreveport, Louisiana, USA
| | - Bharat Guthikonda
- Department of Neurosurgery, Ochsner LSU Medical Center, Louisiana State University, Shreveport, Louisiana, USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Shi S, Jaoube JA, Kanwar R, Jin MC, Amorin A, Varanasi V, Eisinger E, Thomas R, Moore JM. Neurological adverse effects due to programmed death 1 (PD-1) inhibitors. J Neurooncol 2020; 148:291-297. [DOI: 10.1007/s11060-020-03514-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/18/2020] [Indexed: 02/07/2023]
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Gomez-Paz S, Akamatsu Y, Moore JM, Ogilvy CS, Thomas AJ, Griessenauer CJ. Implications of the Collar Sign in Incompletely Occluded Aneurysms after Pipeline Embolization Device Implantation: A Follow-Up Study. AJNR Am J Neuroradiol 2020; 41:482-485. [PMID: 32054613 DOI: 10.3174/ajnr.a6415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/27/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The angiographic collar sign has been recently described in patients with incompletely occluded aneurysms after Pipeline Embolization Device implantation. The long-term implications of this sign are unknown. We report angiographic outcomes of patients with the collar sign with follow-up of up to 45 months and the implications of this angiographic finding. MATERIALS AND METHODS We performed a retrospective review of a prospectively maintained data base of patients who underwent Pipeline Embolization Device implantation for an intracranial aneurysm at our institution between January 2014 and December 2016. We included patients with a collar sign at the initial follow-up angiogram after Pipeline Embolization Device implantation. RESULTS A total of 198 patients with 285 aneurysms were screened for the collar sign on initial and subsequent follow-up angiograms. There were 226 aneurysms (79.3%) with complete occlusion at the first follow-up. Of 59 incompletely occluded aneurysms, 19 (32.2%) aneurysms in 17 patients were found to have a collar sign on the first angiographic follow-up (median, 6 months; range, 4.2-7.2). Ten (52.6%) aneurysms underwent retreatment with a second Pipeline Embolization Device, which resulted in aneurysm occlusion in 1 (10%) patient. There were only 3 (15.8%) aneurysms with complete occlusion at the last follow-up, 2 (10.5%) of which had a single Pipeline Embolization Device implantation and another single (5.3%) aneurysm with a second Pipeline Embolization Device implantation. CONCLUSIONS A collar sign on the initial angiogram after Pipeline Embolization Device placement is a predictor of poor aneurysm occlusion. Because the occlusion rates remain equally low regardless of retreatment in patients with a collar sign, radiologic follow-up may be more appropriate than retreatment.
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Affiliation(s)
- S Gomez-Paz
- From the Neurosurgical Service (S.G-P., Y.A., J.M.M., C.S.O., A.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Y Akamatsu
- From the Neurosurgical Service (S.G-P., Y.A., J.M.M., C.S.O., A.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - J M Moore
- From the Neurosurgical Service (S.G-P., Y.A., J.M.M., C.S.O., A.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - C S Ogilvy
- From the Neurosurgical Service (S.G-P., Y.A., J.M.M., C.S.O., A.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - A J Thomas
- From the Neurosurgical Service (S.G-P., Y.A., J.M.M., C.S.O., A.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - C J Griessenauer
- Department of Neurosurgery (C.J.G.), Geisinger, Danville, Pennsylvania
- Research Institute of Neurointervention (C.J.G.), Paracelsus Medical University, Salzburg, Austria
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80
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Spencer JR, Stern SA, Moore JM, Weaver HA, Singer KN, Olkin CB, Verbiscer AJ, McKinnon WB, Parker JW, Beyer RA, Keane JT, Lauer TR, Porter SB, White OL, Buratti BJ, El-Maarry MR, Lisse CM, Parker AH, Throop HB, Robbins SJ, Umurhan OM, Binzel RP, Britt DT, Buie MW, Cheng AF, Cruikshank DP, Elliott HA, Gladstone GR, Grundy WM, Hill ME, Horanyi M, Jennings DE, Kavelaars JJ, Linscott IR, McComas DJ, McNutt RL, Protopapa S, Reuter DC, Schenk PM, Showalter MR, Young LA, Zangari AM, Abedin AY, Beddingfield CB, Benecchi SD, Bernardoni E, Bierson CJ, Borncamp D, Bray VJ, Chaikin AL, Dhingra RD, Fuentes C, Fuse T, Gay PL, Gwyn SDJ, Hamilton DP, Hofgartner JD, Holman MJ, Howard AD, Howett CJA, Karoji H, Kaufmann DE, Kinczyk M, May BH, Mountain M, Pätzold M, Petit JM, Piquette MR, Reid IN, Reitsema HJ, Runyon KD, Sheppard SS, Stansberry JA, Stryk T, Tanga P, Tholen DJ, Trilling DE, Wasserman LH. The geology and geophysics of Kuiper Belt object (486958) Arrokoth. Science 2020; 367:science.aay3999. [PMID: 32054694 DOI: 10.1126/science.aay3999] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 01/27/2020] [Indexed: 11/02/2022]
Abstract
The Cold Classical Kuiper Belt, a class of small bodies in undisturbed orbits beyond Neptune, is composed of primitive objects preserving information about Solar System formation. In January 2019, the New Horizons spacecraft flew past one of these objects, the 36-kilometer-long contact binary (486958) Arrokoth (provisional designation 2014 MU69). Images from the flyby show that Arrokoth has no detectable rings, and no satellites (larger than 180 meters in diameter) within a radius of 8000 kilometers. Arrokoth has a lightly cratered, smooth surface with complex geological features, unlike those on previously visited Solar System bodies. The density of impact craters indicates the surface dates from the formation of the Solar System. The two lobes of the contact binary have closely aligned poles and equators, constraining their accretion mechanism.
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Affiliation(s)
- J R Spencer
- Southwest Research Institute, Boulder, CO 80302, USA.
| | - S A Stern
- Southwest Research Institute, Boulder, CO 80302, USA
| | - J M Moore
- NASA Ames Research Center, Moffett Field, CA 94035-1000, USA
| | - H A Weaver
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - K N Singer
- Southwest Research Institute, Boulder, CO 80302, USA
| | - C B Olkin
- Southwest Research Institute, Boulder, CO 80302, USA
| | - A J Verbiscer
- Department of Astronomy, University of Virginia, Charlottesville, VA 22904, USA
| | - W B McKinnon
- Department of Earth and Planetary Sciences and McDonnell Center for the Space Sciences, Washington University, St. Louis, MO 63130, USA
| | - J Wm Parker
- Southwest Research Institute, Boulder, CO 80302, USA
| | - R A Beyer
- SETI Institute, Mountain View, CA 94043, USA.,NASA Ames Research Center, Moffett Field, CA 94035-1000, USA
| | - J T Keane
- Division of Geological and Planetary Sciences, California Institute of Technology, Pasadena, CA 91125, USA
| | - T R Lauer
- National Science Foundation's National Optical Infrared Astronomy Research Laboratory, Tucson, AZ 26732, USA
| | - S B Porter
- Southwest Research Institute, Boulder, CO 80302, USA
| | - O L White
- SETI Institute, Mountain View, CA 94043, USA.,NASA Ames Research Center, Moffett Field, CA 94035-1000, USA
| | - B J Buratti
- Jet Propulsion Laboratory, California Institute of Technology Pasadena, CA 91109, USA
| | - M R El-Maarry
- Department of Earth and Planetary Sciences, Birkbeck, University of London, London WC1E 7HX, UK.,University College London, Gower St, Bloomsbury, London WC1E 6BT, UK
| | - C M Lisse
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - A H Parker
- Southwest Research Institute, Boulder, CO 80302, USA
| | - H B Throop
- Independent Consultant, Washington, D.C., USA
| | - S J Robbins
- Southwest Research Institute, Boulder, CO 80302, USA
| | - O M Umurhan
- NASA Ames Research Center, Moffett Field, CA 94035-1000, USA
| | - R P Binzel
- Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - D T Britt
- Department of Physics, University of Central Florida, Orlando, FL 32816, USA
| | - M W Buie
- Southwest Research Institute, Boulder, CO 80302, USA
| | - A F Cheng
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - D P Cruikshank
- NASA Ames Research Center, Moffett Field, CA 94035-1000, USA
| | - H A Elliott
- Southwest Research Institute, San Antonio, TX 78238, USA
| | - G R Gladstone
- Southwest Research Institute, San Antonio, TX 78238, USA
| | - W M Grundy
- Lowell Observatory, Flagstaff, AZ 86001, USA.,Department of Astronomy and Planetary Science, Northern Arizona University, Flagstaff, AZ, 86011, USA
| | - M E Hill
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M Horanyi
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO 80303, USA
| | - D E Jennings
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - J J Kavelaars
- National Research Council of Canada, Victoria, BC V9E 2E7, Canada
| | - I R Linscott
- Independent Consultant, Mountain View, CA 94043, USA
| | - D J McComas
- Department of Astrophysical Sciences, Princeton University, Princeton, NJ 08544, USA
| | - R L McNutt
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - S Protopapa
- Southwest Research Institute, Boulder, CO 80302, USA
| | - D C Reuter
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - P M Schenk
- Lunar and Planetary Institute, Houston, TX 77058, USA
| | | | - L A Young
- Southwest Research Institute, Boulder, CO 80302, USA
| | - A M Zangari
- Southwest Research Institute, Boulder, CO 80302, USA
| | - A Y Abedin
- National Research Council of Canada, Victoria, BC V9E 2E7, Canada
| | | | - S D Benecchi
- Planetary Science Institute, Tucson, AZ 85719, USA
| | - E Bernardoni
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO 80303, USA
| | - C J Bierson
- Earth and Planetary Science Department, University of California, Santa Cruz, CA 95064, USA
| | - D Borncamp
- Decipher Technology Studios, Alexandria, VA 22314, USA
| | - V J Bray
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ 85721, USA
| | - A L Chaikin
- Independent Science Writer, Arlington, VT 05250, USA
| | | | - C Fuentes
- Universidad de Chile, Centro de Astrofísica y Tecnologías Afines, Santiago, Chile
| | - T Fuse
- Kashima Space Technology Center, National Institute of Information and Communications Technology, Kashima, Ibaraki 314-8501, Japan
| | - P L Gay
- Planetary Science Institute, Tucson, AZ 85719, USA
| | - S D J Gwyn
- National Research Council of Canada, Victoria, BC V9E 2E7, Canada
| | - D P Hamilton
- Department of Astronomy, University of Maryland, College Park, MD 20742, USA
| | - J D Hofgartner
- Jet Propulsion Laboratory, California Institute of Technology Pasadena, CA 91109, USA
| | - M J Holman
- Center for Astrophysics, Harvard-Smithsonian Center for Astrophysics, Cambridge, MA 02138, USA
| | - A D Howard
- Department of Environmental Sciences, University of Virginia, Charlottesville, VA 22904, USA
| | - C J A Howett
- Southwest Research Institute, Boulder, CO 80302, USA
| | - H Karoji
- National Institutes of Natural Sciences, Tokyo, Japan
| | - D E Kaufmann
- Southwest Research Institute, Boulder, CO 80302, USA
| | - M Kinczyk
- Marine, Earth, and Atmospheric Sciences, North Carolina State University, Raleigh, NC 27695, USA
| | - B H May
- Independent Collaborator, Windlesham GU20 6YW, UK
| | - M Mountain
- Association of Universities for Research in Astronomy, Washington, DC 20004, USA
| | - M Pätzold
- Rheinisches Institut für Umweltforschung an der Universität zu Köln, Cologne 50931, Germany
| | - J M Petit
- Institut Univers, Temps-fréquence, Interfaces, Nanostructures, Atmosphère et environnement, Molécules, Unité Mixte de Recherche, Centre National de la Recherche Scientifique, Universite Bourgogne Franche Comte, F-25000 Besancon, France
| | - M R Piquette
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO 80303, USA
| | - I N Reid
- Space Telescope Science Institute, Baltimore, MD 21218, USA
| | | | - K D Runyon
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - S S Sheppard
- Department of Terrestrial Magnetism, Carnegie Institution for Science, Washington, DC 20015, USA
| | - J A Stansberry
- Space Telescope Science Institute, Baltimore, MD 21218, USA
| | - T Stryk
- Roane State Community College, Oak Ridge, TN 37830, USA
| | - P Tanga
- Université Côte d'Azur, Observatoire de la Côte d'Azur, Laboratoire Lagrange/ Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7293, 06304 Nice Cedex 4, France
| | - D J Tholen
- Institute for Astronomy, University of Hawaii, Honolulu, HI 96822, USA
| | - D E Trilling
- Department of Astronomy and Planetary Science, Northern Arizona University, Flagstaff, AZ, 86011, USA
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81
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Grundy WM, Bird MK, Britt DT, Cook JC, Cruikshank DP, Howett CJA, Krijt S, Linscott IR, Olkin CB, Parker AH, Protopapa S, Ruaud M, Umurhan OM, Young LA, Dalle Ore CM, Kavelaars JJ, Keane JT, Pendleton YJ, Porter SB, Scipioni F, Spencer JR, Stern SA, Verbiscer AJ, Weaver HA, Binzel RP, Buie MW, Buratti BJ, Cheng A, Earle AM, Elliott HA, Gabasova L, Gladstone GR, Hill ME, Horanyi M, Jennings DE, Lunsford AW, McComas DJ, McKinnon WB, McNutt RL, Moore JM, Parker JW, Quirico E, Reuter DC, Schenk PM, Schmitt B, Showalter MR, Singer KN, Weigle GE, Zangari AM. Color, composition, and thermal environment of Kuiper Belt object (486958) Arrokoth. Science 2020; 367:science.aay3705. [PMID: 32054693 DOI: 10.1126/science.aay3705] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 01/22/2020] [Indexed: 11/02/2022]
Abstract
The outer Solar System object (486958) Arrokoth (provisional designation 2014 MU69) has been largely undisturbed since its formation. We studied its surface composition using data collected by the New Horizons spacecraft. Methanol ice is present along with organic material, which may have formed through irradiation of simple molecules. Water ice was not detected. This composition indicates hydrogenation of carbon monoxide-rich ice and/or energetic processing of methane condensed on water ice grains in the cold, outer edge of the early Solar System. There are only small regional variations in color and spectra across the surface, which suggests that Arrokoth formed from a homogeneous or well-mixed reservoir of solids. Microwave thermal emission from the winter night side is consistent with a mean brightness temperature of 29 ± 5 kelvin.
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Affiliation(s)
- W M Grundy
- Lowell Observatory, Flagstaff, AZ 86001, USA. .,Department of Astronomy and Planetary Science, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - M K Bird
- Argelander-Institut für Astronomie, University of Bonn, D-53121 Bonn, Germany.,Rheinisches Institut für Umweltforschung, Universität zu Köln, 50931 Cologne, Germany
| | - D T Britt
- University of Central Florida, Orlando, FL 32816, USA
| | - J C Cook
- Pinhead Institute, Telluride, CO 81435, USA
| | | | - C J A Howett
- Southwest Research Institute, Boulder, CO 80302, USA
| | - S Krijt
- Steward Observatory, University of Arizona, Tucson, AZ 85719, USA
| | | | - C B Olkin
- Southwest Research Institute, Boulder, CO 80302, USA
| | - A H Parker
- Southwest Research Institute, Boulder, CO 80302, USA
| | - S Protopapa
- Southwest Research Institute, Boulder, CO 80302, USA
| | - M Ruaud
- NASA Ames Research Center, Moffett Field, CA 94035, USA
| | - O M Umurhan
- NASA Ames Research Center, Moffett Field, CA 94035, USA.,Carl Sagan Center, SETI Institute, Mountain View, CA 94043, USA
| | - L A Young
- Southwest Research Institute, Boulder, CO 80302, USA
| | - C M Dalle Ore
- NASA Ames Research Center, Moffett Field, CA 94035, USA.,Carl Sagan Center, SETI Institute, Mountain View, CA 94043, USA
| | - J J Kavelaars
- National Research Council, Victoria, BC V9E 2E7, Canada.,Department of Physics and Astronomy, University of Victoria, Victoria, BC V8W 2Y2, Canada
| | - J T Keane
- California Institute of Technology, Pasadena, CA 91125, USA
| | - Y J Pendleton
- NASA Ames Research Center, Moffett Field, CA 94035, USA
| | - S B Porter
- Southwest Research Institute, Boulder, CO 80302, USA
| | - F Scipioni
- NASA Ames Research Center, Moffett Field, CA 94035, USA.,Carl Sagan Center, SETI Institute, Mountain View, CA 94043, USA
| | - J R Spencer
- Southwest Research Institute, Boulder, CO 80302, USA
| | - S A Stern
- Southwest Research Institute, Boulder, CO 80302, USA
| | - A J Verbiscer
- University of Virginia, Charlottesville, VA 22904, USA
| | - H A Weaver
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - R P Binzel
- Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - M W Buie
- Southwest Research Institute, Boulder, CO 80302, USA
| | - B J Buratti
- NASA Jet Propulsion Laboratory, La Cañada Flintridge, CA 91011, USA
| | - A Cheng
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - A M Earle
- Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - H A Elliott
- Southwest Research Institute, San Antonio, TX 78238, USA
| | - L Gabasova
- Institut de Planétologie et d'Astrophysique de Grenoble, Centre National de la Recherche Scientifique, Université Grenoble Alpes, Grenoble, France
| | - G R Gladstone
- Southwest Research Institute, San Antonio, TX 78238, USA
| | - M E Hill
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M Horanyi
- University of Colorado, Boulder, CO 80309, USA
| | - D E Jennings
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - A W Lunsford
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - D J McComas
- Princeton University, Princeton, NJ 08544, USA
| | | | - R L McNutt
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - J M Moore
- NASA Ames Research Center, Moffett Field, CA 94035, USA
| | - J W Parker
- Southwest Research Institute, Boulder, CO 80302, USA
| | - E Quirico
- Institut de Planétologie et d'Astrophysique de Grenoble, Centre National de la Recherche Scientifique, Université Grenoble Alpes, Grenoble, France
| | - D C Reuter
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - P M Schenk
- Lunar and Planetary Institute, Houston, TX 77058, USA
| | - B Schmitt
- Institut de Planétologie et d'Astrophysique de Grenoble, Centre National de la Recherche Scientifique, Université Grenoble Alpes, Grenoble, France
| | - M R Showalter
- Carl Sagan Center, SETI Institute, Mountain View, CA 94043, USA
| | - K N Singer
- Southwest Research Institute, Boulder, CO 80302, USA
| | - G E Weigle
- Big Head Endian LLC, Leawood, KS 67019, USA
| | - A M Zangari
- Southwest Research Institute, Boulder, CO 80302, USA
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82
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Ascanio LC, Enriquez-Marulanda A, Maragkos GA, Salem MM, Alturki AY, Ravindran K, Fehnel CR, Hanafy K, Ogilvy CS, Thomas AJ, Moore JM. Effect of Blood Pressure Variability During the Acute Period of Subarachnoid Hemorrhage on Functional Outcomes. Neurosurgery 2020; 87:779-787. [DOI: 10.1093/neuros/nyaa019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 12/01/2019] [Indexed: 01/14/2023] Open
Abstract
Abstract
BACKGROUND
The association of blood pressure variation with poor outcomes in aneurysmal subarachnoid hemorrhage (aSAH) is unknown.
OBJECTIVE
To evaluate the association of systolic blood pressure (SBP) variation and clinical outcomes in aSAH.
METHODS
We conducted a retrospective chart review of all aSAH patients treated at an academic institution between 2007 and 2016. Patient demographics, aSAH characteristics, and blood pressure observations for the first 24 h of admission in 4-h intervals were obtained. SBP variability metrics assessed were mean, standard deviation, maximum, minimum, peak, trough, coefficient of variation, and successive variation. The primary outcome was a composite of the modified Rankin scale as good (0-2) or poor (3-6) at last follow-up. Comparisons between outcome groups were performed. Logistic regression models for each significant SBP metric controlling for potential confounders were constructed.
RESULTS
The study population was 202 patients. The mean age was 57 yr; 66% were female. The median follow-up time was 18 mo; 57 (29%) patients had a poor outcome. Patients with poor outcomes had higher standard deviation (17.1 vs 14.7 mmHg, P = .01), peak (23.5 vs 20.0 mmHg, P = .02), trough (22.6 vs 19.2 mmHg, P < .01), coefficient of variation (13.9 vs 11.8 mmHg, P < .01), and lower minimum SBP (101.4 vs 108.4, P < .01). The logistic regression showed that every 1-mmHg increase in the minimum SBP increased the odds of good outcomes (odds ratio = 1.03; 95% CI = 1.001-1.064; P = .04). Models including other SBP metrics were not significant.
CONCLUSION
Hypotension was found to be independently associated with poor outcomes in patients with aSAH.
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Affiliation(s)
- Luis C Ascanio
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Georgios A Maragkos
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Abdulrahman Y Alturki
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery, The National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Krishnan Ravindran
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Corey R Fehnel
- Neurology Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Khalid Hanafy
- Neurology Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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83
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McKinnon WB, Richardson DC, Marohnic JC, Keane JT, Grundy WM, Hamilton DP, Nesvorný D, Umurhan OM, Lauer TR, Singer KN, Stern SA, Weaver HA, Spencer JR, Buie MW, Moore JM, Kavelaars JJ, Lisse CM, Mao X, Parker AH, Porter SB, Showalter MR, Olkin CB, Cruikshank DP, Elliott HA, Gladstone GR, Parker JW, Verbiscer AJ, Young LA. The solar nebula origin of (486958) Arrokoth, a primordial contact binary in the Kuiper Belt. Science 2020; 367:science.aay6620. [PMID: 32054695 DOI: 10.1126/science.aay6620] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/27/2020] [Indexed: 11/02/2022]
Abstract
The New Horizons spacecraft's encounter with the cold classical Kuiper Belt object (486958) Arrokoth (provisional designation 2014 MU69) revealed a contact-binary planetesimal. We investigated how Arrokoth formed and found that it is the product of a gentle, low-speed merger in the early Solar System. Its two lenticular lobes suggest low-velocity accumulation of numerous smaller planetesimals within a gravitationally collapsing cloud of solid particles. The geometric alignment of the lobes indicates that they were a co-orbiting binary that experienced angular momentum loss and subsequent merger, possibly because of dynamical friction and collisions within the cloud or later gas drag. Arrokoth's contact-binary shape was preserved by the benign dynamical and collisional environment of the cold classical Kuiper Belt and therefore informs the accretion processes that operated in the early Solar System.
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Affiliation(s)
- W B McKinnon
- Department of Earth and Planetary Sciences and McDonnell Center for the Space Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA.
| | - D C Richardson
- Department of Astronomy, University of Maryland, College Park, MD 20742, USA
| | - J C Marohnic
- Department of Astronomy, University of Maryland, College Park, MD 20742, USA
| | - J T Keane
- Division of Geological and Planetary Sciences, California Institute of Technology, Pasadena, CA 91125, USA
| | - W M Grundy
- Lowell Observatory, Flagstaff, AZ 86001, USA.,Department of Astronomy and Planetary Science, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - D P Hamilton
- Department of Astronomy, University of Maryland, College Park, MD 20742, USA
| | - D Nesvorný
- Division of Space Science and Engineering, Southwest Research Institute, Boulder, CO 80302, USA
| | - O M Umurhan
- NASA Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA.,SETI Institute, Mountain View, CA 94043, USA
| | - T R Lauer
- National Optical-Infrared Astronomy Research Laboratory, National Science Foundation, Tucson, AZ 85726, USA
| | - K N Singer
- Division of Space Science and Engineering, Southwest Research Institute, Boulder, CO 80302, USA
| | - S A Stern
- Division of Space Science and Engineering, Southwest Research Institute, Boulder, CO 80302, USA
| | - H A Weaver
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - J R Spencer
- National Research Council of Canada, Victoria, BC V9E 2E7, Canada
| | - M W Buie
- Division of Space Science and Engineering, Southwest Research Institute, Boulder, CO 80302, USA
| | - J M Moore
- NASA Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | - J J Kavelaars
- National Research Council of Canada, Victoria, BC V9E 2E7, Canada
| | - C M Lisse
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - X Mao
- Department of Earth and Planetary Sciences and McDonnell Center for the Space Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - A H Parker
- Division of Space Science and Engineering, Southwest Research Institute, Boulder, CO 80302, USA
| | - S B Porter
- Division of Space Science and Engineering, Southwest Research Institute, Boulder, CO 80302, USA
| | | | - C B Olkin
- Division of Space Science and Engineering, Southwest Research Institute, Boulder, CO 80302, USA
| | - D P Cruikshank
- NASA Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | - H A Elliott
- Division of Space Science and Engineering, Southwest Research Institute, San Antonio, TX 78238, USA.,Department of Physics and Astronomy, University of Texas, San Antonio, TX 78249, USA
| | - G R Gladstone
- Division of Space Science and Engineering, Southwest Research Institute, San Antonio, TX 78238, USA
| | - J Wm Parker
- Division of Space Science and Engineering, Southwest Research Institute, Boulder, CO 80302, USA
| | - A J Verbiscer
- Department of Astronomy, University of Virginia, Charlottesville, VA 22904, USA
| | - L A Young
- Division of Space Science and Engineering, Southwest Research Institute, Boulder, CO 80302, USA
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84
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Gomez-Paz S, Maragkos GA, Salem MM, Ascanio LC, Lee M, Enriquez-Marulanda A, Orrego-Gonzalez E, Kicielinski K, Moore JM, Ogilvy CS, Thomas AJ. Symptomatic Hemorrhage From Cerebral Cavernous Malformations: Evidence from a Cohort Study. World Neurosurg 2019; 135:e477-e487. [PMID: 31843731 DOI: 10.1016/j.wneu.2019.12.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/06/2019] [Accepted: 12/07/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Patients with a cerebral cavernous malformation (CCM) can have intracranial hemorrhages ranging from insignificant and chronic microbleeds to life-threatening hemorrhage. Management decisions and patient counseling are based on a heterogeneous body of evidence. We sought to improve the literature by providing our results based on the standardized definitions and aimed to delineate differences in the symptomatic burden for CCMs, based on their anatomic location and presence of developmental venous anomalies. This evidence will aid in clinical decision making and patient counseling. METHODS A retrospective cohort analysis between 1990 and 2018 was performed, including patients with a diagnosis of a CCM. The primary outcome was acute symptomatic hemorrhages. RESULTS We identified 438 patients harboring 632 CCMs. Mean age at diagnosis was 50 years (standard deviation ±17 years). Median follow-up was 26 months (interquartile range, 7-72 hours). Multiple lesions were encountered in 64 patients (15%). An initial symptomatic presentation was observed in 64% of the patients. There were 438 supratentorial lesions (69%) and 194 infratentorial lesions (31%). A symptomatic hemorrhage was observed in 25% of the supratentorial lesions and 29% of the infratentorial lesions (P < 0.001). A linear mixed-effects regression model showed a significant difference in developing a symptomatic hemorrhage at diagnosis or follow-up between CCMs with an infratentorial location and those with a supratentorial location (odds ratio, 1.81; 95% confidence interval, 1.17-2.81; P = 0.008). CONCLUSIONS Infratentorial cavernous malformations are more likely to present with symptomatic hemorrhages at diagnosis or during follow-up when accounting for size differences between lesions.
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Affiliation(s)
- Santiago Gomez-Paz
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Georgios A Maragkos
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Luis C Ascanio
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle Lee
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Eduardo Orrego-Gonzalez
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly Kicielinski
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Ascanio LC, Gupta R, Adeeb N, Moore JM, Griessenauer CJ, Mayeku J, Tachie-Baffour Y, Thomas R, Alturki AY, Schmalz PGR, Ogilvy CS, Thomas AJ. Relationship between external ventricular drain clamp trials and ventriculoperitoneal shunt insertion following nontraumatic subarachnoid hemorrhage: a single-center study. J Neurosurg 2019; 130:956-962. [PMID: 29547083 DOI: 10.3171/2017.10.jns171644] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/02/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Currently, there is no established standard regarding the ideal number of external ventricular drain (EVD) clamp trials performed before ventriculoperitoneal (VP) shunt insertion following nontraumatic subarachnoid hemorrhage (SAH). In this study, the authors aimed to evaluate this relationship. METHODS A retrospective review of all patients presenting with SAH between July 2007 and December 2016 was performed. Patients with SAH who had received an EVD within the first 24 hours of hospital admission and had undergone at least 1 clamp trial prior to EVD removal were eligible for inclusion in the study. Patient demographics, clinical presentations, SAH etiologies and grades, clamp trial data, hospital lengths of stay, and functional outcomes were recorded. RESULTS One hundred fourteen patients with nontraumatic SAH complicated by posthemorrhagic hydrocephalus were included in the study. The median patient age was 57 years (range 28-90 years), with a male/female ratio of 1:1.7. A ruptured aneurysm was the underlying etiology of SAH in 79.8% of patients. A majority of patients (69.4%) had a Hunt and Hess grade III-V on admission. The median number of clamp trials performed was 2 (range 1-6). A VP shunt was required in 40.4% of patients. In those who underwent 2 and 3 clamp trials, 60% and 38.9%, respectively, did not require subsequent VP shunt placement. CONCLUSIONS Surgical placement of a VP shunt is associated with complications. Clamp trials are routinely performed before making the decision to insert a shunt. In the present study, the authors found that a significant percentage of patients passed their second and third clamp trials without requiring subsequent shunt insertion. These data support performing multiple clamp trials prior to shunt placement.
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Affiliation(s)
- Luis C Ascanio
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Raghav Gupta
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Nimer Adeeb
- 2Department of Neurosurgery, Louisiana State University, Shreveport, Louisiana
| | - Justin M Moore
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School.,3Department of Neurosurgery, Boston Medical Center, Boston University, Boston, Massachusetts
| | | | - Julie Mayeku
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Yaw Tachie-Baffour
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Ranjit Thomas
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Abdulrahman Y Alturki
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School.,5Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; and
| | - Philip G R Schmalz
- 6Department of Neurosurgery, University of Alabama at Birmingham Medical Center, Birmingham, Alabama
| | - Christopher S Ogilvy
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Ajith J Thomas
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School
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86
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Phan K, Dmytriw AA, Teng I, Moore JM, Griessenauer C, Ogilvy C, Thomas A. A Direct Aspiration First Pass Technique vs Standard Endovascular Therapy for Acute Stroke: A Systematic Review and Meta-Analysis. Neurosurgery 2019; 83:19-28. [PMID: 28973527 DOI: 10.1093/neuros/nyx386] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 06/10/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The direct aspiration first pass technique (ADAPT) is a recent endovascular treatment for ischemic stroke due to large vessel occlusion that has been gaining popularity due to the rapidity of the technique and the potential for cost savings in comparison to standard thrombectomy methods such as stent retrievers. However, few studies have directly compared these 2. OBJECTIVE To compare ADAPT with stent retrievers for thrombectomy via systematic review and meta-analysis. METHODS Ovid Medline, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ACP Journal Club, and Database of Abstracts of Review of Effectiveness limited to English through September 2016 were systematically searched. Eligible studies included those in which patient cohorts underwent ADAPT for acute stroke. Recanalization efficiency, clinical outcomes, and complication rates of ADAPT were compared with the current standard of endovascular thrombectomy techniques. RESULTS Seventeen studies on ADAPT and 5 randomized controlled trials on endovascular therapy were included. ADAPT achieved higher rates of complete revascularisation (89.4% vs 71.7%, P < .001) but similar clinical outcomes compared to front-line endovascular therapy. Seventy-one point four percent of ADAPT cases were successfully recanalized with aspiration alone, and a trend towards reduced time from groin puncture to recanalization time was noted (44.77 vs 61.46 min, P = .088). CONCLUSION The pooled results are comparable with recent randomized studies that demonstrate the benefit of endovascular therapy over intra-arterial medical therapy. Future direct comparative studies and randomized trials are required to confirm the benefit of the ADAPT strategy compared to standard endovascular therapy for acute ischemic stroke.
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Affiliation(s)
- Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia
| | - Adam A Dmytriw
- Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ian Teng
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia
| | - Justin M Moore
- Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christoph Griessenauer
- Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christopher Ogilvy
- Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajith Thomas
- Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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87
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Salem MM, Sweid A, Kuhn AL, Dmytriw AA, Waqas M, Adeeb N, Kan P, Puri AS, Marotta TR, Levy EI, Moore JM, Ogilvy CS, Jabbour P, Thomas AJ. Repeat Flow Diversion for Previously Failed Flow Diversion in A Multicenter Cohort. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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88
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Orrego-González E, Enriquez-Marulanda A, Ascanio LC, Jordan N, Hanafy KA, Moore JM, Ogilvy CS, Thomas AJ. A Cohort Comparison Analysis of Fixed Pressure Ventriculoperitoneal Shunt Valves With Programmable Valves for Hydrocephalus Following Nontraumatic Subarachnoid Hemorrhage. Oper Neurosurg (Hagerstown) 2019; 18:374-383. [DOI: 10.1093/ons/opz195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 04/16/2019] [Indexed: 12/24/2022] Open
Abstract
AbstractBACKGROUNDHydrocephalus after nontraumatic subarachnoid hemorrhage (SAH) is a common sequela that may require the placement of ventriculoperitoneal shunts (VPS). Adjustable-pressure valves (APVs) are being widely used in this situation though more expensive than differential-pressure valves (DPVs).OBJECTIVETo compare outcomes between APV and DPV in SAH-induced hydrocephalus.METHODSWe performed a retrospective chart review of patients with nontraumatic SAH who underwent VPS placement for the treatment of hydrocephalus after SAH, between July 2007 and December 2016. Patients were classified according to the type of valve (APV vs DPV). We evaluated factors that could predict the type of valve used, outcomes in VPS revision/replacement rate, and complications.RESULTSA total of 66 patients underwent VPS placement who were equally distributed into the 2 groups of valves. VPS failure with the need for revision/replacement occurred in 13 (19.7%) cases. Ten (30.3%) patients with DPV had a VPS failure, while 3 (9.1%) patients with an APV had a similar failure with the need for revision/replacement (P = .03). VPS placement before discharge during the initial hospitalization (P = .02) was statistically significant associated with the use of a DPV, while the reason of external ventricular drain (EVD) failure (P = .03) was associated with the use of an APV.CONCLUSIONAPVs had a lower rate of surgical revisions compared to DPVs. Early placement of VPS was associated with the use of a DPV. The need for EVD replacement due to EVD infection or malfunction was associated with higher rates of APV use.
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Affiliation(s)
- Eduardo Orrego-González
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Universidad Icesi. Facultad de Ciencias de la Salud. Cali, Colombia
| | | | - Luis C Ascanio
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Noah Jordan
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Khalid A Hanafy
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Justin M Moore
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christopher S Ogilvy
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajith J Thomas
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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89
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Gupta R, Ogilvy CS, Moore JM, Griessenauer CJ, Enriquez-Marulanda A, Leadon M, Adeeb N, Ascanio L, Maragkos GA, Jain A, Schmalz PGR, Alturki AY, Kicielinski K, Schirmer CM, Thomas AJ. Proposal of a follow-up imaging strategy following Pipeline flow diversion treatment of intracranial aneurysms. J Neurosurg 2019; 131:32-39. [PMID: 30004284 DOI: 10.3171/2018.2.jns172673] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 02/08/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is currently no standardized follow-up imaging strategy for intracranial aneurysms treated with the Pipeline embolization device (PED). Here, the authors use follow-up imaging data for aneurysms treated with the PED to propose a standardizable follow-up imaging strategy. METHODS A retrospective review of all patients who underwent treatment for ruptured or unruptured intracranial aneurysms with the PED between March 2013 and March 2017 at 2 major academic institutions in the US was performed. RESULTS A total of 218 patients underwent treatment for 259 aneurysms with the PED and had undergone at least 1 follow-up imaging session to assess aneurysm occlusion status. There were 235 (90.7%) anterior and 24 posterior (9.3%) circulation aneurysms. On Kaplan-Meier analysis, the cumulative incidences of aneurysm occlusion at 6, 12, 18, and 24 months were 38.2%, 77.8%, 84.2%, and 85.1%, respectively. No differences in the cumulative incidence of aneurysm occlusion according to aneurysm location (p = 0.39) or aneurysm size (p = 0.81) were observed. A trend toward a decreased cumulative incidence of aneurysm occlusion in patients 70 years or older was observed (p = 0.088). No instances of aneurysm rupture after PED treatment or aneurysm recurrence after occlusion were noted. Sixteen (6.2%) aneurysms were re-treated with the PED; 11 of these had imaging follow-up data available, demonstrating occlusion in 3 (27.3%). CONCLUSIONS The authors propose a follow-up imaging strategy that incorporates 12-month digital subtraction angiography and 24-month MRA for patients younger than 70 years and single-session digital subtraction angiography at 12 months in patients 70 years or older. For recurrent or persistent aneurysms, re-treatment with the PED or use of an alternative treatment modality may be considered.
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Affiliation(s)
- Raghav Gupta
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Christopher S Ogilvy
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Justin M Moore
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Christoph J Griessenauer
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and.,2Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Alejandro Enriquez-Marulanda
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Madeline Leadon
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Nimer Adeeb
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Luis Ascanio
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Georgios A Maragkos
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Abhi Jain
- 2Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Philip G R Schmalz
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Abdulrahman Y Alturki
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Kimberly Kicielinski
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Clemens M Schirmer
- 2Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Ajith J Thomas
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
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Mackel CE, Devaiah A, Holsapple J, Moore JM. Neural Crest Cell Failure as Embryogenesis for Fusiform Aneurysm of the Anterior Communicating Artery: Case Report and Review of the Literature. World Neurosurg 2019; 129:232-236. [PMID: 31203061 DOI: 10.1016/j.wneu.2019.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pure fusiform aneurysms of the anterior communicating artery (AcomA) are rare. We report a unique case of a patient with an AComA fusiform aneurysm in the setting of several unusual cranial neurocristopathies, including a hypoplastic internal carotid artery (ICA), persistent craniopharyngeal canal, transsphenoidal encephalocele, and ectopic, duplicated pituitary gland. We also review the literature on cranial base neurocristopathies and AComA fusiform aneurysms. CASE DESCRIPTION This 46-year-old patient had a history of short stature, osteoporosis, obesity, cleft lip, decreased libido, congenital left eye blindness, headaches, and chronic nasal congestion. Magnetic resonance imaging revealed a 25 × 25 × 33 mm heterogenous soft tissue mass with an ectopic pituitary gland extending transsphenoidally and a duplicated pituitary stalk. A hormone panel revealed undetectable insulin-like growth factor 1 and growth hormone, central hypogonadism, and elevated prolactin. Before presentation, computed tomography angiography (CTA) had revealed a congenitally hypoplastic right ICA and 4.7 × 10.7 mm fusiform aneurysm of the AComA. Digital subtraction angiography confirmed stable morphology after 9 years. Nonoperative management of aneurysm and cephalocele was elected, with repeat CTA in 1 year. CONCLUSIONS This case provides evidence that inherent arterial wall defects can contribute to fusiform aneurysm formation in the AComA. We propose that small AComA fusiform aneurysms without sclerotic or symptomatic features can be safely observed by describing the longest reported conservative management for this type of aneurysm. A high degree of suspicion for cerebrovascular anomalies should be maintained in patients who present with cranial neurocristopathy.
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Affiliation(s)
- Charles E Mackel
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
| | - Anand Devaiah
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - James Holsapple
- Department of Neurosurgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Justin M Moore
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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91
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Adeeb N, Thakur JD, Moore JM, Guthikonda B. Commentary: Supracerebellar Transtentorial Approach for Occipital Meningioma to Maximize Visual Preservation: Technical Note. Oper Neurosurg (Hagerstown) 2019; 17:E184-E185. [DOI: 10.1093/ons/opz137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/19/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nimer Adeeb
- Department of Neurosurgery, Ochsner LSU Medical Center, Louisiana State University, Shreveport, Louisiana
| | - Jai Deep Thakur
- Department of Neurosurgery, Ochsner LSU Medical Center, Louisiana State University, Shreveport, Louisiana
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Bharat Guthikonda
- Department of Neurosurgery, Ochsner LSU Medical Center, Louisiana State University, Shreveport, Louisiana
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Stern SA, Weaver HA, Spencer JR, Olkin CB, Gladstone GR, Grundy WM, Moore JM, Cruikshank DP, Elliott HA, McKinnon WB, Parker JW, Verbiscer AJ, Young LA, Aguilar DA, Albers JM, Andert T, Andrews JP, Bagenal F, Banks ME, Bauer BA, Bauman JA, Bechtold KE, Beddingfield CB, Behrooz N, Beisser KB, Benecchi SD, Bernardoni E, Beyer RA, Bhaskaran S, Bierson CJ, Binzel RP, Birath EM, Bird MK, Boone DR, Bowman AF, Bray VJ, Britt DT, Brown LE, Buckley MR, Buie MW, Buratti BJ, Burke LM, Bushman SS, Carcich B, Chaikin AL, Chavez CL, Cheng AF, Colwell EJ, Conard SJ, Conner MP, Conrad CA, Cook JC, Cooper SB, Custodio OS, Dalle Ore CM, Deboy CC, Dharmavaram P, Dhingra RD, Dunn GF, Earle AM, Egan AF, Eisig J, El-Maarry MR, Engelbrecht C, Enke BL, Ercol CJ, Fattig ED, Ferrell CL, Finley TJ, Firer J, Fischetti J, Folkner WM, Fosbury MN, Fountain GH, Freeze JM, Gabasova L, Glaze LS, Green JL, Griffith GA, Guo Y, Hahn M, Hals DW, Hamilton DP, Hamilton SA, Hanley JJ, Harch A, Harmon KA, Hart HM, Hayes J, Hersman CB, Hill ME, Hill TA, Hofgartner JD, Holdridge ME, Horányi M, Hosadurga A, Howard AD, Howett CJA, Jaskulek SE, Jennings DE, Jensen JR, Jones MR, Kang HK, Katz DJ, Kaufmann DE, Kavelaars JJ, Keane JT, Keleher GP, Kinczyk M, Kochte MC, Kollmann P, Krimigis SM, Kruizinga GL, Kusnierkiewicz DY, Lahr MS, Lauer TR, Lawrence GB, Lee JE, Lessac-Chenen EJ, Linscott IR, Lisse CM, Lunsford AW, Mages DM, Mallder VA, Martin NP, May BH, McComas DJ, McNutt RL, Mehoke DS, Mehoke TS, Nelson DS, Nguyen HD, Núñez JI, Ocampo AC, Owen WM, Oxton GK, Parker AH, Pätzold M, Pelgrift JY, Pelletier FJ, Pineau JP, Piquette MR, Porter SB, Protopapa S, Quirico E, Redfern JA, Regiec AL, Reitsema HJ, Reuter DC, Richardson DC, Riedel JE, Ritterbush MA, Robbins SJ, Rodgers DJ, Rogers GD, Rose DM, Rosendall PE, Runyon KD, Ryschkewitsch MG, Saina MM, Salinas MJ, Schenk PM, Scherrer JR, Schlei WR, Schmitt B, Schultz DJ, Schurr DC, Scipioni F, Sepan RL, Shelton RG, Showalter MR, Simon M, Singer KN, Stahlheber EW, Stanbridge DR, Stansberry JA, Steffl AJ, Strobel DF, Stothoff MM, Stryk T, Stuart JR, Summers ME, Tapley MB, Taylor A, Taylor HW, Tedford RM, Throop HB, Turner LS, Umurhan OM, Van Eck J, Velez D, Versteeg MH, Vincent MA, Webbert RW, Weidner SE, Weigle GE, Wendel JR, White OL, Whittenburg KE, Williams BG, Williams KE, Williams SP, Winters HL, Zangari AM, Zurbuchen TH. Initial results from the New Horizons exploration of 2014 MU 69, a small Kuiper Belt object. Science 2019; 364:364/6441/eaaw9771. [PMID: 31097641 DOI: 10.1126/science.aaw9771] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/16/2019] [Indexed: 11/02/2022]
Abstract
The Kuiper Belt is a distant region of the outer Solar System. On 1 January 2019, the New Horizons spacecraft flew close to (486958) 2014 MU69, a cold classical Kuiper Belt object approximately 30 kilometers in diameter. Such objects have never been substantially heated by the Sun and are therefore well preserved since their formation. We describe initial results from these encounter observations. MU69 is a bilobed contact binary with a flattened shape, discrete geological units, and noticeable albedo heterogeneity. However, there is little surface color or compositional heterogeneity. No evidence for satellites, rings or other dust structures, a gas coma, or solar wind interactions was detected. MU69's origin appears consistent with pebble cloud collapse followed by a low-velocity merger of its two lobes.
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Affiliation(s)
- S A Stern
- Southwest Research Institute, Boulder, CO 80302, USA.
| | - H A Weaver
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - J R Spencer
- Southwest Research Institute, Boulder, CO 80302, USA
| | - C B Olkin
- Southwest Research Institute, Boulder, CO 80302, USA
| | - G R Gladstone
- Southwest Research Institute, San Antonio, TX 78238, USA
| | - W M Grundy
- Lowell Observatory, Flagstaff, AZ 86001, USA
| | - J M Moore
- NASA Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | - D P Cruikshank
- NASA Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | - H A Elliott
- Southwest Research Institute, San Antonio, TX 78238, USA.,Department of Physics and Astronomy, University of Texas, San Antonio, TX 78249, USA
| | - W B McKinnon
- Department of Earth and Planetary Sciences and McDonnell Center for the Space Sciences, Washington University, St. Louis, MO 63130, USA
| | - J Wm Parker
- Southwest Research Institute, Boulder, CO 80302, USA
| | - A J Verbiscer
- Department of Astronomy, University of Virginia, Charlottesville, VA 22904, USA
| | - L A Young
- Southwest Research Institute, Boulder, CO 80302, USA
| | - D A Aguilar
- Independent consultant, Carbondale, CO 81623, USA
| | - J M Albers
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - T Andert
- Universität der Bundeswehr München, Neubiberg 85577, Germany
| | - J P Andrews
- Southwest Research Institute, Boulder, CO 80302, USA
| | - F Bagenal
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO 80303, USA
| | - M E Banks
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - B A Bauer
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | - K E Bechtold
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - C B Beddingfield
- NASA Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA.,SETI Institute, Mountain View, CA 94043, USA
| | - N Behrooz
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - K B Beisser
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - S D Benecchi
- Planetary Science Institute, Tucson, AZ 85719, USA
| | - E Bernardoni
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO 80303, USA
| | - R A Beyer
- NASA Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA.,SETI Institute, Mountain View, CA 94043, USA
| | - S Bhaskaran
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - C J Bierson
- Earth and Planetary Science Department, University of California, Santa Cruz, CA 95064, USA
| | - R P Binzel
- Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - E M Birath
- Southwest Research Institute, Boulder, CO 80302, USA
| | - M K Bird
- Argelander-Institut für Astronomie, University of Bonn, Bonn D-53121, Germany.,Rheinisches Institut für Umweltforschung, Universität zu Köln, Cologne 50931, Germany
| | - D R Boone
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - A F Bowman
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - V J Bray
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ 85721, USA
| | - D T Britt
- Department of Physics, University of Central Florida, Orlando, FL 32816, USA
| | - L E Brown
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M R Buckley
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M W Buie
- Southwest Research Institute, Boulder, CO 80302, USA
| | - B J Buratti
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - L M Burke
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - S S Bushman
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - B Carcich
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA.,Cornell University, Ithaca, NY 14853, USA
| | - A L Chaikin
- Independent science writer, Arlington, VT 05250, USA
| | - C L Chavez
- NASA Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA.,SETI Institute, Mountain View, CA 94043, USA
| | - A F Cheng
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - E J Colwell
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - S J Conard
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M P Conner
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - C A Conrad
- Southwest Research Institute, Boulder, CO 80302, USA
| | - J C Cook
- Pinhead Institute, Telluride, CO 81435, USA
| | - S B Cooper
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - O S Custodio
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - C M Dalle Ore
- NASA Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA.,SETI Institute, Mountain View, CA 94043, USA
| | - C C Deboy
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - P Dharmavaram
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | - G F Dunn
- Southwest Research Institute, San Antonio, TX 78238, USA
| | - A M Earle
- Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - A F Egan
- Southwest Research Institute, Boulder, CO 80302, USA
| | - J Eisig
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M R El-Maarry
- Department of Earth and Planetary Sciences, Birkbeck, University of London, London WC1E 7HX, UK
| | - C Engelbrecht
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - B L Enke
- Southwest Research Institute, Boulder, CO 80302, USA
| | - C J Ercol
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - E D Fattig
- Southwest Research Institute, San Antonio, TX 78238, USA
| | - C L Ferrell
- Southwest Research Institute, Boulder, CO 80302, USA
| | - T J Finley
- Southwest Research Institute, Boulder, CO 80302, USA
| | - J Firer
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | - W M Folkner
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - M N Fosbury
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - G H Fountain
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - J M Freeze
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - L Gabasova
- University Grenoble Alpes, Centre National de la Recherche Scientifique, Institut de Planétologie et d'Astrophysique de Grenoble, 38000 Grenoble, France
| | - L S Glaze
- NASA Headquarters, Washington, DC 20546, USA
| | - J L Green
- NASA Headquarters, Washington, DC 20546, USA
| | - G A Griffith
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - Y Guo
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M Hahn
- Rheinisches Institut für Umweltforschung, Universität zu Köln, Cologne 50931, Germany
| | - D W Hals
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - D P Hamilton
- Department of Astronomy, University of Maryland, College Park, MD 20742, USA
| | - S A Hamilton
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - J J Hanley
- Southwest Research Institute, San Antonio, TX 78238, USA
| | - A Harch
- Cornell University, Ithaca, NY 14853, USA
| | - K A Harmon
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - H M Hart
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - J Hayes
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - C B Hersman
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M E Hill
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - T A Hill
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - J D Hofgartner
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - M E Holdridge
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M Horányi
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO 80303, USA
| | - A Hosadurga
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - A D Howard
- Department of Environmental Sciences, University of Virginia, Charlottesville, VA 22904, USA
| | - C J A Howett
- Southwest Research Institute, Boulder, CO 80302, USA
| | - S E Jaskulek
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - D E Jennings
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - J R Jensen
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M R Jones
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - H K Kang
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - D J Katz
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - D E Kaufmann
- Southwest Research Institute, Boulder, CO 80302, USA
| | - J J Kavelaars
- National Research Council of Canada, Victoria, BC V9E 2E7, Canada
| | - J T Keane
- Division of Geological and Planetary Sciences, California Institute of Technology, Pasadena, CA 91125, USA
| | - G P Keleher
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M Kinczyk
- Marine, Earth, and Atmospheric Sciences, North Carolina State University, Raleigh, NC 27695, USA
| | - M C Kochte
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - P Kollmann
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - S M Krimigis
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - G L Kruizinga
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - D Y Kusnierkiewicz
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M S Lahr
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - T R Lauer
- National Optical Astronomy Observatory, Tucson, AZ 26732, USA
| | - G B Lawrence
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - J E Lee
- NASA Marshall Space Flight Center, Huntsville, AL 35812, USA
| | | | - I R Linscott
- Independent consultant, Mountain View, CA 94043, USA
| | - C M Lisse
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - A W Lunsford
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - D M Mages
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - V A Mallder
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - N P Martin
- Independent consultant, Crested Butte, CO 81224, USA
| | - B H May
- Independent collaborator, Windlesham GU20 6YW, UK
| | - D J McComas
- Southwest Research Institute, San Antonio, TX 78238, USA.,Department of Astrophysical Sciences, Princeton University, Princeton, NJ 08544, USA
| | - R L McNutt
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - D S Mehoke
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - T S Mehoke
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | - H D Nguyen
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - J I Núñez
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - A C Ocampo
- NASA Headquarters, Washington, DC 20546, USA
| | - W M Owen
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - G K Oxton
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - A H Parker
- Southwest Research Institute, Boulder, CO 80302, USA
| | - M Pätzold
- Rheinisches Institut für Umweltforschung, Universität zu Köln, Cologne 50931, Germany
| | | | | | - J P Pineau
- Stellar Solutions, Palo Alto, CA 94306, USA
| | - M R Piquette
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO 80303, USA
| | - S B Porter
- Southwest Research Institute, Boulder, CO 80302, USA
| | - S Protopapa
- Southwest Research Institute, Boulder, CO 80302, USA
| | - E Quirico
- University Grenoble Alpes, Centre National de la Recherche Scientifique, Institut de Planétologie et d'Astrophysique de Grenoble, 38000 Grenoble, France
| | - J A Redfern
- Southwest Research Institute, Boulder, CO 80302, USA
| | - A L Regiec
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | - D C Reuter
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - D C Richardson
- Department of Astronomy, University of Maryland, College Park, MD 20742, USA
| | - J E Riedel
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - M A Ritterbush
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - S J Robbins
- Southwest Research Institute, Boulder, CO 80302, USA
| | - D J Rodgers
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - G D Rogers
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - D M Rose
- Southwest Research Institute, Boulder, CO 80302, USA
| | - P E Rosendall
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - K D Runyon
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M G Ryschkewitsch
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M M Saina
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | - P M Schenk
- Lunar and Planetary Institute, Houston, TX 77058, USA
| | - J R Scherrer
- Southwest Research Institute, San Antonio, TX 78238, USA
| | - W R Schlei
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - B Schmitt
- University Grenoble Alpes, Centre National de la Recherche Scientifique, Institut de Planétologie et d'Astrophysique de Grenoble, 38000 Grenoble, France
| | - D J Schultz
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - D C Schurr
- NASA Headquarters, Washington, DC 20546, USA
| | - F Scipioni
- NASA Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA.,SETI Institute, Mountain View, CA 94043, USA
| | - R L Sepan
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - R G Shelton
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | - M Simon
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - K N Singer
- Southwest Research Institute, Boulder, CO 80302, USA
| | - E W Stahlheber
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | - J A Stansberry
- Space Telescope Science Institute, Baltimore, MD 21218, USA
| | - A J Steffl
- Southwest Research Institute, Boulder, CO 80302, USA
| | - D F Strobel
- Johns Hopkins University, Baltimore, MD 21218, USA
| | - M M Stothoff
- Southwest Research Institute, San Antonio, TX 78238, USA
| | - T Stryk
- Roane State Community College, Oak Ridge, TN 37830, USA
| | - J R Stuart
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - M E Summers
- George Mason University, Fairfax, VA 22030, USA
| | - M B Tapley
- Southwest Research Institute, San Antonio, TX 78238, USA
| | - A Taylor
- KinetX Aerospace, Tempe, AZ 85284, USA
| | - H W Taylor
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - R M Tedford
- Southwest Research Institute, Boulder, CO 80302, USA
| | - H B Throop
- Planetary Science Institute, Tucson, AZ 85719, USA
| | - L S Turner
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - O M Umurhan
- NASA Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA.,SETI Institute, Mountain View, CA 94043, USA
| | - J Van Eck
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - D Velez
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - M H Versteeg
- Southwest Research Institute, San Antonio, TX 78238, USA
| | - M A Vincent
- Southwest Research Institute, Boulder, CO 80302, USA
| | - R W Webbert
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - S E Weidner
- Department of Astrophysical Sciences, Princeton University, Princeton, NJ 08544, USA
| | - G E Weigle
- Independent consultant, Burden, KS 67019, USA
| | - J R Wendel
- NASA Headquarters, Washington, DC 20546, USA
| | - O L White
- NASA Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA.,SETI Institute, Mountain View, CA 94043, USA
| | - K E Whittenburg
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | | | - S P Williams
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - H L Winters
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - A M Zangari
- Southwest Research Institute, Boulder, CO 80302, USA
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93
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Tapia MA, Lee JR, Gereau GB, Moore JM, Weise VN, Mason KL, Cessac ME, Bodeen JL, Miller DK, Will MJ. Sigma-1 receptor antagonist PD144418 suppresses food reinforced operant responding in rats. Behav Brain Res 2019; 362:71-76. [PMID: 30639509 DOI: 10.1016/j.bbr.2019.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/08/2019] [Accepted: 01/08/2019] [Indexed: 01/20/2023]
Abstract
Sigma-1 (σ1) receptors have been investigated for their involvement in learning, rewarding and motivational processes, particularly as it relates to substances of abuse. Few studies have examined the effects of σ1 receptor agonists and antagonists on the rewarding and motivational properties of natural reinforcers, such as food. Studies that have investigated σ1 receptor agonists and antagonists has produced conflicting results. σ1 receptor antagonist PD144418 has been found to produce a dose-dependent attenuation of locomotor activity induced by cocaine, and by itself, does not suppress basal locomotor activity in mice. However, its effects on reward and motivation as it relates to food are unknown. The present study examined the involvement of σ1 receptors in mediating the rewarding and motivational properties of food using an operant task. The results indicated that at the highest dose (10 μmol/kg), PD144418 significantly attenuated the number of active lever responses for chow pellets but did not decrease the number of active lever responses for sucrose pellets under a fixed ratio (FR2) schedule of reinforcement. However, under a progressive ratio (PR) reinforcement schedule, 10 μmol/kg of PD14418 significantly reduced the breakpoint, a measure indicative of effort or motivation, for both chow and sucrose pellets. When ad libitum chow or sucrose pellets were made freely available (i.e. no lever press required) inside the operant chamber, 10 μmol/kg, PD144418 did not have an effect on number of pellets consumed. These findings indicate that PD144418 reduces the motivational effort of a food reinforced behavior.
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Affiliation(s)
- Melissa A Tapia
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA.
| | - Jenna R Lee
- Interdisciplinary Neuroscience Program, University of Missouri, Columbia, MO 65211, USA
| | - Graydon B Gereau
- Department of Biological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Justin M Moore
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Valerie N Weise
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Kelsey L Mason
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA; Department of Biological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Mikala E Cessac
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA
| | - Jeffrey L Bodeen
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA; Department of Biological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Dennis K Miller
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Matthew J Will
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
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Enriquez-Marulanda A, Salem MM, Ascanio LC, Maragkos GA, Gupta R, Moore JM, Thomas AJ, Ogilvy CS, Alturki AY. No differences in effectiveness and safety between pipeline embolization device and stent-assisted coiling for the treatment of communicating segment internal carotid artery aneurysms. Neuroradiol J 2019; 32:344-352. [PMID: 30998116 DOI: 10.1177/1971400919845368] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Aneurysms arising from the communicating segment (C7) of the internal carotid artery (ICA) are one of the most frequent locations of intracranial aneurysms. Stent-assisted coiling (SAC) and flow diversion therapies are both endovascular strategies used for the treatment of ICA aneurysms occurring at the C7 segment. OBJECTIVE The aim of this study is to compare both methods' angiographic and functional outcomes, and procedural complications. To our knowledge, this is the first study to compare both modalities for aneurysms at this location. METHODS A retrospective review was performed of our prospectively collected database from 2008 until 2017 for patients treated with SAC and from 2013 until 2017 for patients treated with pipeline embolization devices (PEDs). RESULTS We identified 35 patients for this cohort with 38 aneurysms; 17 treated with SAC and 21 with PED. Mean age was 59 years, and 30 patients were female (86%). Complete occlusion at last follow-up occurred in 70.6% of patients in the SAC group and in 81% in the PED group (p = 0.45). Posterior communicating artery patency at last follow-up did not differ significantly between the two groups (94.1% vs 85.7%; p = 0.40). Good functional outcome at last follow-up (mRS 0-2) was achieved in 100% and 88.2% of patients, respectively. Additionally, there was no significant difference between the two groups for retreatment rates, procedural hemorrhagic, or thromboembolic complications. CONCLUSION SAC and PED are two equally efficacious modalities for endovascular treatment of ICA aneurysms arising at the communicating segment of the ICA.
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Affiliation(s)
| | - Mohamed M Salem
- 1 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Luis C Ascanio
- 1 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Georgios A Maragkos
- 1 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Raghav Gupta
- 1 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Justin M Moore
- 1 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ajith J Thomas
- 1 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Abdulrahman Y Alturki
- 1 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,2 Department of Neurosurgery, The National Neuroscience Institute, Riyadh, Saudi Arabia
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95
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Maragkos GA, Alturki AY, Greenstein PE, Enriquez-Marulanda A, Kicielinski KJ, Moore JM, Ogilvy CS, Thomas AJ. Percutaneous Transverse Sinus Cannulation for Dural Arteriovenous Fistula Coiling: Operative Video. World Neurosurg 2019; 127:335. [PMID: 30995549 DOI: 10.1016/j.wneu.2019.04.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 11/30/2022]
Abstract
This is the case of an 84-year old woman, found to have a symptomatic transverse sinus dural arteriovenous fistula. The transverse sinus was isolated from all venous circulation and its arterial feeders stemmed from the occipital artery, precluding both arterial and venous access for effective obliteration of the fistula. Therefore the patient underwent a combined open surgical/endovascular approach, where the sinus was percutaneously cannulated through a single burr hole, allowing access for effective coiling of the fistula. In this video, we present the rationale, feasibility, and technical implications for this procedure.1.
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Affiliation(s)
- Georgios A Maragkos
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Abdulrahman Y Alturki
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Patricia E Greenstein
- Neurology Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Kimberly J Kicielinski
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin M Moore
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ajith J Thomas
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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96
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Dmytriw AA, Phan K, Moore JM, Pereira VM, Krings T, Thomas AJ. On Flow Diversion: The Changing Landscape of Intracerebral Aneurysm Management. AJNR Am J Neuroradiol 2019; 40:591-600. [PMID: 30894358 DOI: 10.3174/ajnr.a6006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/25/2019] [Indexed: 12/15/2022]
Abstract
Uptake of flow-diverting technology is rapidly outpacing the availability of clinical evidence. Most current usage is off-label, and the endovascular community is nearer the beginning than the end of the learning curve, given the number of devices in development. A comprehensive overview of technical specifications alongside key outcome data is essential both for clinical decision-making and to direct further investigations. Most-studied has been the Pipeline Embolization Device, which has undergone a transition to the Pipeline Flex for which outcome data are sparse or heterogeneous. Alternative endoluminal devices do not appear to be outperforming the Pipeline Embolization Device to date, though prospective studies and long-term data mostly are lacking, and between-study comparisons must be treated with caution. Nominal technical specifications may be unrelated to in situ performance, emphasizing the importance of correct radiologic sizing and device placement. Devices designed specifically for bifurcation aneurysms also lack long-term outcome data or have only recently become available for clinical use. There are no major studies directly comparing a flow-diverting device with standard coiling or microsurgical clipping. Data on flow-diverting stents are too limited in terms of long-term outcomes to reliably inform clinical decision-making. The best available evidence supports using a single endoluminal device for most indications. Recommendations on the suitability and choice of a device for bifurcation or ruptured aneurysms or for anatomically complex lesions cannot be made on the basis of current evidence. The appropriateness of flow-diverting treatment must be decided on a case-by-case basis, considering experience and the relative risks against standard approaches or observation.
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Affiliation(s)
- A A Dmytriw
- From the Department of Medical Imaging (A.A.D., V.M.P., T.K.), Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada .,Neurosurgical Service (A.A.D., K.P., J.M.M., A.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - K Phan
- Neurosurgical Service (A.A.D., K.P., J.M.M., A.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,NeuroSpine Surgery Research Group (K.P.), Prince of Wales Private Hospital, Sydney, Australia
| | - J M Moore
- Neurosurgical Service (A.A.D., K.P., J.M.M., A.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - V M Pereira
- From the Department of Medical Imaging (A.A.D., V.M.P., T.K.), Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - T Krings
- From the Department of Medical Imaging (A.A.D., V.M.P., T.K.), Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - A J Thomas
- Neurosurgical Service (A.A.D., K.P., J.M.M., A.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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97
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Ogilvy CS, Jordan NJ, Ascanio LC, Enriquez-Marulanda AA, Salem MM, Moore JM, Thomas AJ. Surgical and Endovascular Comprehensive Treatment Outcomes of Unruptured Intracranial Aneurysms: Reduction of Treatment Bias. World Neurosurg 2019; 126:e878-e887. [PMID: 30872200 DOI: 10.1016/j.wneu.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/01/2019] [Accepted: 03/02/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Determining the risks of treatment of unruptured intracranial aneurysms is critical in the decision-making process of management. Most studies have reported the results for endovascular or surgical management. Our objective was to better delineate the risk estimates for unruptured intracranial aneurysms treated with surgical or endovascular techniques in a comprehensive fashion, according to the patients' risk profiles. METHODS Data were gathered from 553 patients with 658 unruptured intracranial aneurysms treated at a single institution from 2014 to 2017. The decision to treat was determined by a projected morbidity that was lower than the natural history rupture risk. Data on aneurysm size, location, patient age, and outcome at the last clinical visit (modified Rankin scale scores) were collected and analyzed retrospectively. RESULTS The mean patient age was 59 years, and the mean lesion size was 7.3 mm. Microsurgical clipping was used in 251 lesions (38.2%), endovascular coiling in 70 (10.6%), stent-assisted coiling in 89 (13.5%), and a pipeline embolization device in 248 (37.7%). Complications from the procedures or during hospital admission occurred 66 lesions (10% of the total). Of these 66 complications, 28 (4.32% of the total) were non-neurological, treated, and resolved without permanent morbidity. Neurologic complications occurred in 38 procedures (5.7% of the total). Of these, 7 (1%) resulted in a permanent poor outcome (modified Rankin scale score, 3-6). CONCLUSION Aneurysmal obliteration using endovascular and surgical approaches in a comprehensive fashion has low treatment risks for unruptured aneurysms. The nomograms generated are useful in the discussion with patients and families regarding the risks of total institutional treatment of unruptured aneurysms.
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Affiliation(s)
- Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States.
| | - Noah J Jordan
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Luis C Ascanio
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Alejandro A Enriquez-Marulanda
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
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Singer KN, McKinnon WB, Gladman B, Greenstreet S, Bierhaus EB, Stern SA, Parker AH, Robbins SJ, Schenk PM, Grundy WM, Bray VJ, Beyer RA, Binzel RP, Weaver HA, Young LA, Spencer JR, Kavelaars JJ, Moore JM, Zangari AM, Olkin CB, Lauer TR, Lisse CM, Ennico K. Impact craters on Pluto and Charon indicate a deficit of small Kuiper belt objects. Science 2019; 363:955-959. [PMID: 30819958 DOI: 10.1126/science.aap8628] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/05/2019] [Indexed: 11/02/2022]
Abstract
The flyby of Pluto and Charon by the New Horizons spacecraft provided high-resolution images of cratered surfaces embedded in the Kuiper belt, an extensive region of bodies orbiting beyond Neptune. Impact craters on Pluto and Charon were formed by collisions with other Kuiper belt objects (KBOs) with diameters from ~40 kilometers to ~300 meters, smaller than most KBOs observed directly by telescopes. We find a relative paucity of small craters ≲13 kilometers in diameter, which cannot be explained solely by geological resurfacing. This implies a deficit of small KBOs (≲1 to 2 kilometers in diameter). Some surfaces on Pluto and Charon are likely ≳4 billion years old, thus their crater records provide information on the size-frequency distribution of KBOs in the early Solar System.
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99
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Enriquez-Marulanda A, Ravindran K, Salem MM, Ascanio LC, Kan P, Srinivasan VM, Griessenauer CJ, Schirmer CM, Jain A, Moore JM, Ogilvy CS, Thomas AJ, Alturki AY. Evaluation of Radiological Features of the Posterior Communicating Artery and Their Impact on Efficacy of Saccular Aneurysm Treatment with the Pipeline Embolization Device: A Case Series Study. World Neurosurg 2019; 125:e998-e1007. [PMID: 30771544 DOI: 10.1016/j.wneu.2019.01.228] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Posterior communicating artery segment aneurysms are one of the most frequent intracranial aneurysms. Currently, limited data have described the use of the pipeline embolization device (PED) in these aneurysms. METHODS We conducted a multicenter retrospective review of 3 prospectively collected databases of patients treated with the PED from January 2013 to December 2017. The primary objective was to assess the efficacy and safety of the PED in the treatment of saccular posterior communicating artery (PComA) aneurysms. We also assessed the effect of anatomical variations on the angiographic and clinical outcomes, including the presence of fetal PComA, vessel origin relationship to the aneurysm, and patency after PED placement. RESULTS We identified 57 patients with 60 saccular aneurysms; Their mean age was 60.5 years, and 49 were female (86.0%). A total of 55 aneurysms (91.7%) were unruptured. The median imaging follow-up duration was 8.5 months. Complete occlusion at the last imaging follow-up study was 84.0%. At the last follow-up examination, 94.5% of patients had a modified Rankin scale score of ≤2. The presence of fetal PComA, origin type, and patency during follow-up did have a significant effect on aneurysm occlusion (P = 0.61, P = 0.40, and P = 0.14, respectively). CONCLUSIONS PED use for treatment of PComA aneurysms resulted in acceptable occlusion rates. The present study did not find that fetal PComA, its origin, or its patency during follow-up had an effect on aneurysm occlusion.
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Affiliation(s)
| | - Krishnan Ravindran
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Luis C Ascanio
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Christoph J Griessenauer
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA; Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | | | - Abhi Jain
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Abdulrahman Y Alturki
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia.
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100
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Lee JR, Tapia MA, Nelson JR, Moore JM, Gereau GB, Childs TE, Vieira-Potter VJ, Booth FW, Will MJ. Sex dependent effects of physical activity on diet preference in rats selectively bred for high or low levels of voluntary wheel running. Behav Brain Res 2019; 359:95-103. [DOI: 10.1016/j.bbr.2018.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/15/2018] [Accepted: 10/12/2018] [Indexed: 12/20/2022]
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