1
|
Doron O, Patel AB, Hawryluk GWJ. Neurovascular Interventions for Neurotrauma: From Treatment of Injured Vessels to Treatment of the Injured Brain? Oper Neurosurg (Hagerstown) 2024; 26:247-255. [PMID: 37976141 DOI: 10.1227/ons.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/17/2023] [Indexed: 11/19/2023] Open
Abstract
Traumatic brain injury is often associated with a direct or secondary neurovascular pathology. In this review, we present recent advancements in endovascular neurosurgery that enable accurate and effective vessel reconstruction with emphasis on its role in early diagnosis, the expanding use of flow diversion in pseudoaneurysms, and traumatic arteriovenous fistulas. In addition, future directions in which catheter-based interventions could potentially affect traumatic brain injury are described: targeting blood brain barrier integrity using the advantages of intra-arterial drug delivery of blood brain barrier stabilizers to prevent secondary brain edema, exploring the impact of endovascular venous access as a means to modulate venous outflow in an attempt to reduce intracranial pressure and augment brain perfusion, applying selective intra-arterial hypothermia as a neuroprotection method mitigating some of the risks conferred by systemic cooling, trans-vessel wall delivery of regenerative therapy agents, and shifting attention using multimodal neuromonitoring to post-traumatic vasospasm to further characterize the role it plays in secondary brain injury. Thus, we believe that the potential of endovascular tools can be expanded because they enable access to the "highways" governing perfusion and flow and call for further research focused on exploring these routes because it may contribute to novel endovascular approaches currently used for treating injured vessels, harnessing them for treatment of the injured brain.
Collapse
Affiliation(s)
- Omer Doron
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston , Massachusetts , USA
- Department of Biomedical Engineering, The Aldar and Iby Fleischman Faculty of Engineering, Tel Aviv University, Tel Aviv , Israel
| | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston , Massachusetts , USA
| | - Gregory W J Hawryluk
- Department of Neurosurgery, Akron General Neuroscience Institute, Cleveland Clinic, Akron , Ohio , USA
| |
Collapse
|
2
|
Maramattom BV. Cerebral Dural Venous Sinus Stenting: Endovascular Technique. Neurol India 2024; 72:34-38. [PMID: 38442998 DOI: 10.4103/neurol-india.neurol-india-d-23-00539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/22/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Boby V Maramattom
- Department of Neurology, Apollo Adlux Hospital, Angamaly, Kochi, Keralam, India
| |
Collapse
|
3
|
Abdalkader M, Hui F, Amans MR, Raz E, Hanning U, Ma A, Brinjikji W, Malek AM, Oxley TJ, Nguyen TN. Cerebral venous disorders: Diagnosis and endovascular management. J Neuroradiol 2023; 50:581-592. [PMID: 37331820 DOI: 10.1016/j.neurad.2023.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023]
Abstract
The role of the venous circulation in neurological diseases has been underestimated. In this review, we present an overview of the intracranial venous anatomy, venous disorders of the central nervous system, and options for endovascular management. We discuss the role the venous circulation plays in various neurological diseases including cerebrospinal fluid (CSF) disorders (intracranial hypertension and intracranial hypotension), arteriovenous diseases, and pulsatile tinnitus. We also shed light on emergent cerebral venous interventions including transvenous brain-computer interface implantation, transvenous treatment of communicating hydrocephalus, and the endovascular treatment of CSF-venous disorders.
Collapse
Affiliation(s)
- Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Ferdinand Hui
- Neuroscience Institute, Division of Neurointerventional Surgery, Queen's Medical Center, Honolulu, Hawaii, USA
| | - Matthew R Amans
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Eytan Raz
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alice Ma
- Department of Neurosurgery, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
| | | | - Adel M Malek
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Thomas J Oxley
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Thanh N Nguyen
- Department of Neurology, Neurosurgery and Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Guédon A, Checkouri T, Fantoni M, Civelli V, Labeyrie MA, Saint-Maurice JP, Vallée F, Houdart E. Blood Flow Velocity: a Decision Tool for Stenting Indication in Venous Pulsatile Tinnitus. Clin Neuroradiol 2023; 33:729-737. [PMID: 36856788 DOI: 10.1007/s00062-023-01268-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/24/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND AND PURPOSE Lateral sinus stenosis is the most common cause of venous pulsatile tinnitus (VPT). Stenting is an effective treatment after demonstration of a trans-stenotic pressure gradient; however, pressure measurement has many technical limitations. In 2018, a study showed that a combined approach with intravascular velocity measurement could be effective in identifying most appropriate candidates for stenting. The aim of the present study was to evaluate a new strategy using this biomarker for the indication of stenting even without a significant pressure gradient. MATERIAL AND METHODS Consecutive patients with disabling VPT were included from 2016 to 2019 and analyzed retrospectively. Intrasinusal pressures were measured and blood flow velocities (with a dual-sensor guidewire) were used for the indication of stenting independent of the pressure gradient. We evaluated the clinical outcome after stenting based on this new biomarker. RESULTS A total of 41 patients were treated according to this strategy. At last follow-up (mean = 30.2 months), 32/33 patients (97%) treated by stenting showed complete resolution or a significant decrease in VPT intensity. The use of velocity as the threshold for indicating stenting identified 8 patients (24%) missed by the pressure gradient. Their clinical outcome after stenting was excellent and no complications occurred. CONCLUSION Measurement of sinus blood flow velocity provides a hemodynamic explanation of disease and may be a better tool than pressure gradient for the indication of stenting in VPT.
Collapse
Affiliation(s)
- Alexis Guédon
- Department of Neuroradiology, AP-HP, Lariboisière Hospital, 2, rue Ambroise Paré, 75010, Paris, France.
- School of Medicine, Université Paris Cité, 75006, Paris, France.
- Inserm, UMR_S 1140, Université Paris Cité, 75006, Paris, France.
| | - Thomas Checkouri
- Department of Neuroradiology, AP-HP, Lariboisière Hospital, 2, rue Ambroise Paré, 75010, Paris, France
| | - Matteo Fantoni
- Department of Neuroradiology, AP-HP, Lariboisière Hospital, 2, rue Ambroise Paré, 75010, Paris, France
| | - Vittorio Civelli
- Department of Neuroradiology, AP-HP, Lariboisière Hospital, 2, rue Ambroise Paré, 75010, Paris, France
| | - Marc-Antoine Labeyrie
- Department of Neuroradiology, AP-HP, Lariboisière Hospital, 2, rue Ambroise Paré, 75010, Paris, France
| | - Jean-Pierre Saint-Maurice
- Department of Neuroradiology, AP-HP, Lariboisière Hospital, 2, rue Ambroise Paré, 75010, Paris, France
| | - Fabrice Vallée
- Department of Anesthesiology and Critical Care, AP-HP, Lariboisière Hospital, 75010, Paris, France
- Inserm, UMR_S 942, Université Paris Cité, 75006, Paris, France
- LMS Polytechnique and M3DISIM, Inria, Paris-Saclay University, CEA, Palaiseau, France
| | - Emmanuel Houdart
- Department of Neuroradiology, AP-HP, Lariboisière Hospital, 2, rue Ambroise Paré, 75010, Paris, France
- School of Medicine, Université Paris Cité, 75006, Paris, France
| |
Collapse
|
5
|
Pulssynchroner Tinnitus infolge einer Sinus-marginalis-Stenose. Laryngorhinootologie 2023; 102:329. [PMID: 37141870 DOI: 10.1055/a-2009-8739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
|
6
|
Hsieh YL, Wang S, Wang W. Case Report: Venous pulsatile tinnitus induced by enlarged oblique occipital sinus and resultant diverticulum/dehiscence of the sigmoid-jugular wall. Front Surg 2023; 9:1014649. [PMID: 36684374 PMCID: PMC9852330 DOI: 10.3389/fsurg.2022.1014649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/01/2022] [Indexed: 01/09/2023] Open
Abstract
Pulsatile tinnitus (PT) caused by enlarged oblique occipital sinus (OOS) and resultant diverticulum/dehiscence of the sigmoid-jugular wall has not been described in previous literature. This study recruits one case of PT induced by ipsilateral enlarged OOS and sigmoid-jugular wall diverticulum (case 1) alongside one case of PT induced by ipsilateral enlarged OOS and sigmoid-jugular wall dehiscence (case 2). Various radiologic and computational techniques including computed tomography (CT), magnetic resonance (MR) imaging, Doppler ultrasound, and computational fluid dynamics (CFD) simulation were implemented. Transmastoid sinus wall reconstruction was performed on case 1 with a large sigmoid-jugular diverticulum potentially traumatizing the facial nerve canal. Contrast-enhanced CT or MR venogram images coupling with three-dimensional reconstructed are advantageous in revealing the covert route of OOS that runs under the cerebellum and drains directly into jugular bulb (JB) region. PT in case 1 was successfully eliminated after transmastoid sinus wall reconstruction surgery. Tinnitus handicap inventory score in case 1 reduced from 70 to 0. The ipsilateral jugular outflow mean velocity (Vmn) and flow volume (FVOL) were 42.5 cm/s and 25.9 g/s (case 1 prior to surgery) and 56.6 cm/s and 41.2 g/s (case 2), respectively. Based on CFD simulation, the peak flow velocity in OOS was 1.85 m/s and 2.1 m/s, the wall pressure of the diverticular dome and dehiscence area of the SS-JB wall was 1724.7 Pa and 369.8 Pa in case 1 and 2, respectively. Enlarged OOS caries greater flow kinetic energy that possibly induces sigmoid-jugular wall diverticulum/dehiscence; transmastoid surgical method is safe and therapeutically effective against PT induced by enlarged OOS.
Collapse
Affiliation(s)
- Yue-Lin Hsieh
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China,Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Shenjiang Wang
- Department of Radiology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
| | - Wuqing Wang
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China,Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China,Correspondence: Wuqing Wang
| |
Collapse
|
7
|
Xing Y, Gao S, Zhou Y, Song S, Lu L, Chen J, Dai Y. Surgical treatment of pulsatile tinnitus related to the sigmoid sinus. J Otol 2023; 18:21-25. [PMID: 36820162 PMCID: PMC9937817 DOI: 10.1016/j.joto.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/27/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022] Open
Abstract
Objective Tinnitus-a common clinical symptom-can be categorized into pulsatile tinnitus (PT) and non-PT. Among these, PT is usually associated with sigmoid sinus symptoms, such as sigmoid sinus wall defect or diverticulum, for which various surgical treatments are available. We have discussed the clinical efficacy of surgery for sigmoid sinus-associated PT via the transmastoid approach in this study. Methods We conducted a retrospective review of 4 patients who underwent surgery for sigmoid sinus-associated PT via the transmastoid approach at Nanjing Drum Tower Hospital from January to December 2020. Of these, 2 patients had sigmoid sinus wall defect and 2 had sigmoid sinus diverticulum. Post-operative tinnitus grading and surgical efficacy were determined. Results After surgery, PT dissolved in 3 patients, while tinnitus significantly decreased in 1 patient. During the follow-up period of 12-18 months, none of the 4 patients showed complications related to increased intracranial pressure or venous sinus thrombosis, and tinnitus symptoms disappeared in 3 patients without recurrence, although 1 patient occasionally developed tinnitus. Postoperative thin-slice CTA of the temporal bone indicated that the sigmoid sinus bone wall defect or diverticulum was completely repaired with a thick soft tissue coverage. Conclusion Surgical repair of sigmoid sinus-associated PT via the transmastoid approach deserves clinical promotion as it exhibited better efficiency while being relatively less invasive.
Collapse
Affiliation(s)
- Yuxuan Xing
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China
- Research Institute of Otolaryngology, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Song Gao
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China
- Research Institute of Otolaryngology, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Yuchen Zhou
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China
- Research Institute of Otolaryngology, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
- Department of Otolaryngology Head and Neck Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, People's Republic of China
| | - Shenghua Song
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China
- Research Institute of Otolaryngology, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Ling Lu
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China
- Research Institute of Otolaryngology, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Jie Chen
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China
- Research Institute of Otolaryngology, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
- Corresponding author. Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China.
| | - Yanhong Dai
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China
- Research Institute of Otolaryngology, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
- Corresponding author. Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China.
| |
Collapse
|