151
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Phan K, Moore JM, Griessenauer CJ, Xu J, Teng I, Dmytriw AA, Chiu AH, Ogilvy CS, Thomas A. Ultra-Early Angiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. World Neurosurg 2017; 102:632-638.e1. [PMID: 28365434 DOI: 10.1016/j.wneu.2017.03.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/10/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE After aneurysmal subarachnoid hemorrhage (aSAH), prognosis is affected heavily by the presence of delayed cerebral ischemia (DCI). There is growing recognition of ultra-early angiographic vasospasm (UEAV) occurring within 48 hours of aSAH; however, its relationship with DCI and ultimately prognosis remains unclear. METHODS Various databases limited to the English language through September 2016 were searched systematically. Eligible studies were those comparing UEAV with control non-UEAV outcomes and follow-up. Two independent reviewers evaluated the quality of studies and abstracted the data, with discrepancies resolved by a third. We calculated odds ratios (ORs) and 95% confidence intervals for all outcomes by using random-effects meta-analyses and performed a heterogeneity analysis. RESULTS Four comparative studies were selected for analysis. Pooled analysis demonstrated that UEAV compared with no-UEAV was associated with greater proportion of rupture aneurysms sized greater than 12 mm (38.3% vs. 24.3%, P < 0.00001). A significantly greater number of patients with UEAV had ruptured MCA aneurysms compared with patients without UEAV (29.7% vs. 19.9%, P = 0.005). Compared with no-UEAV, patients with UEAV were significantly associated with symptomatic cerebral vasospasm (OR 2.07, P = 0.05) and DCI/infarction (OR 2.52, P = 0.02). A significant association also was found between UEAV and an unfavorable outcome at follow-up (OR 1.64, P = 0.03) and greater mortality (OR 2.65, P < 0.00001). CONCLUSIONS UEAV was significantly associated with symptomatic cerebral vasospasm, DCI/infarction, unfavorable outcome at follow-up, and greater mortality. Patients with intracerebral hematoma, intraventricular hemorrhage (Fisher Grade IV), larger ruptured aneurysms >12 mm, and an MCA location were more likely to have UEAV.
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Affiliation(s)
- Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia
| | - Justin M Moore
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christoph J Griessenauer
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua Xu
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia
| | - Ian Teng
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia
| | - Adam A Dmytriw
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Albert H Chiu
- Department of Interventional Neuroradiology, Institute of Neurological Sciences, Prince of Wales Hospital and Community Health Services, Prince of Wales Clinical School, University of New South Wales, Randwick, Australia
| | - Christopher S Ogilvy
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ajith Thomas
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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152
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Burlakoti A, Kumaratilake J, Taylor J, Massy-Westropp N, Henneberg M. The cerebral basal arterial network: morphometry of inflow and outflow components. J Anat 2017; 230:833-841. [PMID: 28370065 DOI: 10.1111/joa.12604] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2017] [Indexed: 12/20/2022] Open
Abstract
The aim of this project was to study how the morphology of the incoming and outgoing arterial components of the cerebral basal arterial network influence the blood flow to the brain. The cerebral basal arterial network consists of the circulus arteriosus cerebri anteriorly and the basilar artery posteriorly. Diameters of inflow vessels (bilateral vertebral and internal carotid arteries), connecting vessels (anterior communicating, basilar and bilateral posterior communicating arteries) and outflow vessels (anterior, middle and posterior cerebral arteries) were measured and cross-sectional areas calculated in 51 cadaveric brain specimens. The individual and the average cross-sectional areas of inflow arteries (51.43 mm2 ) were significantly bigger than the major outflow arteries (37.76 mm2 ) but smaller than the combined cross-sectional areas of outflow (37.76 mm2 ) and connecting (25.33 mm2 ) arteries. The difference in the size of arterial cross-sectional area and the presence of the connecting arteries in the cerebral basal arterial network provides a mechanism for lowering peaks in pressure, and demonstrates a function of the cerebral basal arterial network.
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Affiliation(s)
- Arjun Burlakoti
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Jaliya Kumaratilake
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Jamie Taylor
- Magnetic Resonance Imaging Centre, Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Maciej Henneberg
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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153
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Abstract
Subarachnoid hemorrhage (SAH) is a debilitating, although uncommon, type of stroke with high morbidity, mortality, and economic impact. Modern 30-day mortality is as high as 40%, and about 50% of survivors have permanent disability. Care at high-volume centers with dedicated neurointensive care units is recommended. Euvolemia, not hypervolemia, should be targeted, and the aneurysm should be secured early. Neither statin therapy nor magnesium infusions should be initiated for delayed cerebral ischemia. Cerebral vasospasm is just one component of delayed cerebral edema. Hyponatremia is common in subarachnoid hemorrhage and is associated with longer length of stay, but not increased mortality.
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Affiliation(s)
- Jeremy S Dority
- Department of Anesthesiology, University of Kentucky College of Medicine, 800 Rose Street, Suite N202, Lexington, KY 40536-0293, USA.
| | - Jeffrey S Oldham
- Department of Anesthesiology, University of Kentucky College of Medicine, 800 Rose Street, Suite N202, Lexington, KY 40536-0293, USA
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154
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Stuart D, Christian R, Uschmann H. Effectiveness of intrathecal nicardipine on cerebral vasospasm in non-traumatic subarachnoid hemorrhage: a systematic review protocol. ACTA ACUST UNITED AC 2017; 15:628-637. [DOI: 10.11124/jbisrir-2016-002962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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155
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Brinjikji W, Lanzino G. Endovascular treatment of spinal arteriovenous malformations. HANDBOOK OF CLINICAL NEUROLOGY 2017; 143:161-174. [PMID: 28552139 DOI: 10.1016/b978-0-444-63640-9.00016-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Spinal arteriovenous malformations (AVMs) are a rare but treatable cause of myelopathy and spinal cord hemorrhage. The clinical presentation and ideal treatment of these lesions vary widely, primarily due to differences in anatomic and angioarchitectural features. Six well-defined types of fistula have been defined: (1) intradural dorsal AVM; (2) intramedullary AVM; (3) extradural-intradural AVM; (4) intradural ventral AVF; (5) extradural/epidural AVF; and (6) conus medullaris AVM. Each of these lesions have unique clinical presentations and variable natural histories and endovascular treatment options. The principles of endovascular treatment include: (1) a complete understanding of the angioarchitecture and anatomic features of the lesion, including identification of radiculomedullary arteries; (2) careful spinal angiography; (3) identification of treatment goals prior to the procedure (i.e., complete occlusion versus partial occlusion aimed at altering natural history); (4) selection of proper embolic agent; and (5) careful follow-up in both the immediate postoperative setting and long term.
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156
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Murgo M, Cavanagh K, Latham S. Health Related Quality of Life and support needs for sub-arachnoid haemorrhage survivors in New South Wales Australia. Aust Crit Care 2016; 29:146-50. [DOI: 10.1016/j.aucc.2015.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/01/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022] Open
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157
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Mutoh T, Mutoh T, Sasaki K, Nakamura K, Taki Y, Ishikawa T. Value of Three-Dimensional Maximum Intensity Projection Display to Assist in Magnetic Resonance Imaging (MRI)-Based Grading in a Mouse Model of Subarachnoid Hemorrhage. Med Sci Monit 2016; 22:2050-5. [PMID: 27307024 PMCID: PMC4913823 DOI: 10.12659/msm.896499] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Subarachnoid hemorrhage (SAH) is one of the most devastating cerebrovascular disorders. We report on the diagnostic value of three-dimensional (3-D) maximum intensity projection (MIP) reconstruction of T2*-weighted magnetic resonance images (MRI), processed using graphical user interface-based software, to aid in the accurate grading of endovascular-perforation-induced SAH in a mouse model. Material/Methods A total of 30 mice were subjected to SAH by endovascular perforation; three (10%) were scored as grade 0, six (20%) as grade 1, six (20%) as grade 2, eight (27%) as grade 3, and seven (23%) as grade 4 according to T2*-weighted coronal slices. In comparison, none of mice were scored as grade 0, eight (27%) as grade 1, five (17%) as grade 2, nine (30%) as grade 3, and eight (27%) as grade 4 based on subsequent evaluation using reconstructed 3-D MIP images. Results Mice scored as grade 0 (10%; no visible SAH) on T2*-coronal images were categorized as grades 1 (thin/localized SAH) and 3 (thick/diffuse SAH) according to 3-D MIP images. Grades based on T2* 3-D MIP images were more closely correlated with conventional SAH score (r2=0.59; P<0.0001) and neurological score (r2=0.25; P=0.005) than those based on T2*-coronal slices (r2=0.46; P<0.0001 for conventional score and r2=0.15; P=0.035 for neurological score). Conclusions These results suggest that 3-D MIP images generated from T2*-weighted MRI data may be useful for the simple and precise grading of SAH severity in mice to overcome the weakness of the current MRI-based SAH grading system.
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Affiliation(s)
- Tomoko Mutoh
- Department of Nuclear Medicine and Radiology,Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Tatsushi Mutoh
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Kazumasu Sasaki
- Department of Preclinical Evaluation, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Kazuhiro Nakamura
- Department of Radiology, Research Institute for Brain and Blood Vessels-AKITA, Akita, Japan
| | - Yasuyuki Taki
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Tatsuya Ishikawa
- Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-AKITA, Akita, Japan
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158
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159
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Brinjikji W, Yin R, Nasr DM, Lanzino G. Spinal epidural arteriovenous fistulas. J Neurointerv Surg 2016; 8:1305-1310. [PMID: 26790829 DOI: 10.1136/neurintsurg-2015-012181] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 01/30/2023]
Abstract
Spinal epidural arteriovenous fistulas (SEDAVFs) are rare complex lesions often presenting with protean clinical manifestations secondary to compressive symptoms or congestive myelopathy. The imaging manifestations of SEDAVFs on MR angiography/MRI include high T2 signal in the spinal cord, vascular engorgement of the epidural space, and prominent intradural vascular flow voids. Given the complexity of these lesions, they are best characterized anatomically on catheter angiography where careful inspection of arterial feeders and venous drainage patterns can be performed. The imaging hallmark of an SEDAVF on angiography is the presence of a dilated epidural venous pouch through which spinal and paraspinal veins are secondarily opacified. In the lower thoracic and lumbar spine, SEDAVFs are usually located in the ventral epidural space and fed mainly by the anteriorly coursing epidural arteries. In the cervical and upper thoracic spine, SEDAVFs and their feeding arteries are more typically located laterally in the spinal canal. Current treatment options include transarterial or transvenous endovascular embolization with liquid embolic agents or coils, and surgical resection/disconnection of the fistula. Further research is needed to better characterize how and why these lesions form and to identify the best treatment modalities.
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Affiliation(s)
| | - Rong Yin
- Department of Neurology, The General Hospital of Lanzhou Military Command, Lanzhou, China
| | - Deena M Nasr
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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160
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Zech WD, Jackowski C, Schwendener N, Brencicova E, Schuster F, Lombardo P. Postmortem CT versus forensic autopsy: frequent discrepancies of tracheobronchial content findings. Int J Legal Med 2015; 130:191-8. [PMID: 26400026 DOI: 10.1007/s00414-015-1264-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/09/2015] [Indexed: 12/16/2022]
Abstract
In their daily forensic casework, the authors experienced discrepancies of tracheobronchial content findings between postmortem computed tomography (PMCT) and autopsy to an extent previously unnoticed in the literature. The goal of this study was to evaluate such discrepancies in routine forensic cases. A total of 327 cases that underwent PMCT prior to routine forensic autopsy were retrospectively evaluated for tracheal and bronchial contents according to PMCT and autopsy findings. Hounsfield unit (HU) values of tracheobronchial contents, causes of death, and presence of pulmonary edema were assessed in mismatching and matching cases. Comparing contents in PMCT and autopsy in each of the separately evaluated compartments of the respiratory tract low positive predictive values were assessed (trachea, 38.2%; main bronchi, 40%; peripheral bronchi, 69.1%) indicating high discrepancy rates. The majority of tracheobronchial contents were viscous stomach contents in matching cases and low radiodensity materials (i.e., HU < 30) in mismatching cases. The majority of causes of death were cardiac related in the matching cases and skull/brain trauma in the mismatching cases. In mismatching cases, frequency of pulmonary edema was significantly higher than in matching cases. It can be concluded that discrepancies in tracheobronchial contents observed between PMCT and routine forensic autopsy occur in a considerable number of cases. Discrepancies may be explained by the runoff of contents via nose and mouth during external examination and the flow back of tracheal and main bronchial contents into the lungs caused by upright movement of the respiratory tract at autopsy.
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Affiliation(s)
- Wolf-Dieter Zech
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland.
| | - Christian Jackowski
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland
| | - Nicole Schwendener
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland
| | - Eva Brencicova
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland
| | - Frederick Schuster
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Inselspital, Freiburgstrasse 10, Bern, CH-3010, Switzerland
| | - Paolo Lombardo
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland.,Department of Diagnostic Imaging and Radiotherapy of the University of Turin, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
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