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Carnwath TP, Demel SL, Prestigiacomo CJ. Genetics of ischemic stroke functional outcome. J Neurol 2024; 271:2345-2369. [PMID: 38502340 PMCID: PMC11055934 DOI: 10.1007/s00415-024-12263-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/21/2024]
Abstract
Ischemic stroke, which accounts for 87% of cerebrovascular accidents, is responsible for massive global burden both in terms of economic cost and personal hardship. Many stroke survivors face long-term disability-a phenotype associated with an increasing number of genetic variants. While clinical variables such as stroke severity greatly impact recovery, genetic polymorphisms linked to functional outcome may offer physicians a unique opportunity to deliver personalized care based on their patient's genetic makeup, leading to improved outcomes. A comprehensive catalogue of the variants at play is required for such an approach. In this review, we compile and describe the polymorphisms associated with outcome scores such as modified Rankin Scale and Barthel Index. Our search identified 74 known genetic polymorphisms spread across 48 features associated with various poststroke disability metrics. The known variants span diverse biological systems and are related to inflammation, vascular homeostasis, growth factors, metabolism, the p53 regulatory pathway, and mitochondrial variation. Understanding how these variants influence functional outcome may be helpful in maximizing poststroke recovery.
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Affiliation(s)
- Troy P Carnwath
- University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA.
| | - Stacie L Demel
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - Charles J Prestigiacomo
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
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Baker R, Bakali Z, Crocker JS, Mowla A, Smith M, Grossman A, Hagen MC, Prestigiacomo CJ, Shirani P. Tumor Embolic Stroke: The Importance of Pathological Assessment of Clots after Thrombectomy. J Clin Med 2024; 13:1834. [PMID: 38610599 PMCID: PMC11012646 DOI: 10.3390/jcm13071834] [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: 01/30/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 04/14/2024] Open
Abstract
While tumor emboli are a rare cause of stroke in cancer patients, they highlight the importance of gross observations and pathological assessments in the evaluation of clots. In this case report, a 70-year-old male with type 2 diabetes mellitus and coronary artery disease presented with acute left-sided weakness. He was clinically diagnosed with stroke and given alteplase at 1.5 h from last known normal. He then underwent CT angiography that showed right internal carotid artery occlusion and immediate thrombectomy. The recovered clot was white and lipid-like; due to its atypical appearance, it was sent for pathological assessment, where it was shown to bear features of malignancy. Subsequent imaging identified masses indicating malignancy in the left gluteus, right pleural hilum, and spine. Tumor embolic stroke is a rare pathology. Embolic diseases such as strokes and pulmonary embolisms are common in patients with cancer. Embolic stroke of undetermined source (ESUS) represents a significant portion of cancer strokes. Tumor emboli, though rare, may be an underappreciated source of ESUS in cancer patients. We intend for this case to demonstrate the value of pathological assessment for atypical thrombi as well as highlight the etiology of tumor embolic strokes.
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Affiliation(s)
- Richard Baker
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA (M.C.H.)
| | - Zohabe Bakali
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA (M.C.H.)
| | - Jeffrey S. Crocker
- Department of Pharmacology & Systems Physiology, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Ashkan Mowla
- Department of Neurosurgery, University of Southern California, Los Angeles, CA 90033, USA;
| | - Matthew Smith
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA (M.C.H.)
- Department of Neurology & Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
- Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Aaron Grossman
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA (M.C.H.)
- Department of Neurology & Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
- Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Matthew C. Hagen
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA (M.C.H.)
- Department of Pathology & Laboratory Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Charles J. Prestigiacomo
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA (M.C.H.)
- Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Peyman Shirani
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA (M.C.H.)
- Department of Neurology & Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
- Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
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Hoz SS, Ismail M, Palmisciano P, Al-Khazaali YM, Saleh SA, Muthana A, Forbes JA, Prestigiacomo CJ, Zuccarello M, Andaluz N. Cortical incisions and transcortical approaches for intra-axial and intraventricular lesions: A scoping review. Surg Neurol Int 2024; 15:82. [PMID: 38628541 PMCID: PMC11021096 DOI: 10.25259/sni_58_2024] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/11/2024] [Indexed: 04/19/2024] Open
Abstract
Background Transcortical approaches, encompassing various surgical corridors, have been employed to treat an array of intraparenchymal or intraventricular brain pathologies, including tumors, vascular malformations, infections, intracerebral hematomas, and epileptic surgery. Designing cortical incisions relies on the lesion location and characteristics, knowledge of eloquent functional anatomy, and advanced imaging such as tractography. Despite their widespread use in neurosurgery, there is a noticeable lack of systematic studies examining their common lobe access points, associated complications, and prevalent pathologies. This scoping review assesses current evidence to guide the selection of transcortical approaches for treating a variety of intracranial pathologies. Methods A scoping review was conducted using the PRISMA-ScR guidelines, searching PubMed, EMBASE, Scopus, and Web of Science. Studies were included if ≥5 patients operated on using transcortical approaches, with reported data on clinical features, treatments, and outcomes. Data analysis and synthesis were performed. Results A total of 50 articles encompassing 2604 patients were included in the study. The most common primary pathology was brain tumors (60.6%), particularly gliomas (87.4%). The transcortical-transtemporal approach was the most frequently identified cortical approach (70.48%), and the temporal lobe was the most accessed brain lobe (55.68%). The postoperative course outcomes were reported as good (55.52%), poor (28.38%), and death (14.62%). Conclusion Transcortical approaches are crucial techniques for managing a wide range of intracranial lesions, with the transcortical-transtemporal approach being the most common. According to the current literature, the selective choice of cortical incision and surgical corridor based on the lesion's pathology and anatomic-functional location correlates with acceptable functional outcomes.
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Affiliation(s)
- Samer S. Hoz
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, United States
| | - Mustafa Ismail
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati, Cincinnati, United States
| | | | - Saleh A. Saleh
- Department of Neurosurgery, University of Baghdad, Baghdad, Iraq
| | - Ahmed Muthana
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq
| | - Jonathan A. Forbes
- Department of Neurosurgery, University of Cincinnati, Cincinnati, United States
| | | | - Mario Zuccarello
- Department of Neurosurgery, University of Cincinnati, Cincinnati, United States
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, United States
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Johnson MD, Palmisciano P, Yamani AS, Hoz SS, Prestigiacomo CJ. A Systematic Review and Meta-Analysis of 3-Dimensional Morphometric Parameters for Cerebral Aneurysms. World Neurosurg 2024; 183:214-226.e5. [PMID: 38160907 DOI: 10.1016/j.wneu.2023.12.131] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Imaging modalities with increased spatial resolution have allowed for more precise quantification of cerebral aneurysm shape in 3-dimensional (3D) space. We conducted a systematic review and meta-analysis to assess the correlation of individual 3D morphometric measures with cerebral aneurysm rupture status. METHODS Two independent reviewers performed a PRISMA (preferred reporting items of systematic reviews and meta-analysis)-guided literature search to identify articles reporting the association between 3D morphometric measures of intracranial aneurysms and rupture status. RESULTS A total of 15,122 articles were identified. After screening, 39 studies were included. We identified 17 3D morphometric measures, with 11 eligible for the meta-analysis. The meta-analysis showed a significant association with rupture status for the following measures: nonsphericity index (standardized mean difference [SMD], 0.66; 95% confidence interval [CI], 0.53-0.79; P < 0.0001; I2 = 55.2%), undulation index (SMD, 0.55; 95% CI, 0.26-0.85; P = 0.0017; I2 = 68.1%), ellipticity index (SMD, 0.53; 95% CI, 0.29-0.77; P = 0.0005; I2 = 70.8%), volume (SMD, 0.18; 95% CI, 0.02-0.35; P = 0.0320; I2 = 82.3%), volume/ostium ratio (SMD, 0.43; 95% CI, 0.16-0.71; P = 0.0075; I2 = 90.4%), elongation (SMD, -0.94; 95% CI, -1.12 to -0.76; P = 0.0005; I2 = 0%), flatness (SMD, -0.87; 95% CI, -1.04 to -0.71; P = 0.0005; I2 = 0%), and sphericity (SMD, -0.62; 95% CI, -1.06 to -0.17; P = 0.0215; I2 = 67.9%). A significant risk of publication bias was estimated for the ellipticity index (P = 0.0360) and volume (P = 0.0030). CONCLUSIONS Based on the results of a meta-analysis containing 39 studies, the nonsphericity index, undulation index, elongation, flatness, and sphericity demonstrated the most consistent correlation with rupture status.
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Affiliation(s)
- Mark D Johnson
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA.
| | - Paolo Palmisciano
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ali S Yamani
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Samer S Hoz
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Charles J Prestigiacomo
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
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Elfil M, Morsi RZ, Ghozy S, Elmashad A, Siddiqui A, Al-Bayati AR, Alaraj A, Brook A, Kam AW, Chatterjee AR, Patsalides A, Waldau B, Prestigiacomo CJ, Matouk C, Schirmer CM, Altschul D, Parrella DT, Toth G, Jindal G, Shaikh HA, Dolia JN, Fifi JT, Fraser JF, DO JT, Amuluru K, Kim LJ, Harrigan M, Amans MR, Kole M, Mokin M, Abraham M, Jumaa M, Janjua N, Zaidat O, Youssef PP, Khandelwal P, Wang QT, Grandhi R, Hanel R, Kellogg RT, Ortega-Gutierrez S, Sheth S, Nguyen TN, Szeder V, Hu YC, Yoo AJ, Tanweer O, Jankowitz B, Heit JJ, Williamson R, Kass-Hout T, Crowley RW, El-Ghanem M, Al-Mufti F. Factors Affecting Selection of TraineE for Neurointervention (FASTEN). Interv Neuroradiol 2024:15910199241232726. [PMID: 38389309 DOI: 10.1177/15910199241232726] [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] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND AND IMPORTANCE Neurointervention is a very competitive specialty in the United States due to the limited number of training spots and the larger pool of applicants. The training standards are continuously updated to ensure solid training experiences. Factors affecting candidate(s) selection have not been fully established yet. Our study aims to investigate the factors influencing the selection process. METHODS A 52-question survey was distributed to 93 program directors (PDs). The survey consisted of six categories: (a) Program characteristics, (b) Candidate demographics, (c) Educational credentials, (d) Personal traits, (e) Research and extracurricular activities, and (f) Overall final set of characteristics. The response rate was 59.1%. As per the programs' characteristics, neurosurgery was the most involved specialty in running the training programs (69%). Regarding demographics, the need for visa sponsorship held the greatest prominence with a mean score of 5.9 [standard deviation (SD) 2.9]. For the educational credentials, being a graduate from a neurosurgical residency and the institution where the candidate's residency training is/was scored the highest [5.4 (SD = 2.9), 5.4 (SD = 2.5), respectively]. Regarding the personal traits, assessment by faculty members achieved the highest score [8.9 (SD = 1)]. In terms of research/extracurricular activities, fluency in English had the highest score [7.2 (SD = 1.9)] followed by peer-reviewed/PubMed-indexed publications [6.4 (SD = 2.2)]. CONCLUSION Our survey investigated the factors influencing the final decision when choosing the future neurointerventional trainee, including demographic, educational, research, and extracurricular activities, which might serve as valuable guidance for both applicants and programs to refine the selection process.
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Affiliation(s)
- Mohamed Elfil
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Rami Z Morsi
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ahmed Elmashad
- Department of Neurology, Yale University, New Haven, CT, USA
| | - Adnan Siddiqui
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY, USA
| | - Alhamza R Al-Bayati
- Department of Neurology and Neurosurgery, University of Pittsburg Medical Center, Pittsburg, PA, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois, Chicago, IL, USA
| | - Allan Brook
- Department of Neurosurgery, Montefiore Medical Center and Children's Hospital at Montefiore (CHAM), Bronx, NY, USA
| | - Anthony W Kam
- Department of Radiology, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
| | - Arindam Rano Chatterjee
- Interventional Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Athos Patsalides
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
| | - Ben Waldau
- Neurosurgery, University of California Davis, Sacramento, CA, USA
| | - Charles J Prestigiacomo
- Department of Neurological Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Charles Matouk
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | | | - David Altschul
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David T Parrella
- Interventional Neurology, Ascension Saint Thomas Hospital West, Nashville, TN, USA
| | - Gabor Toth
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA
| | - Gaurav Jindal
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Hamza A Shaikh
- Department of Radiology, Cooper University Hospital, Camden, NJ, USA
| | | | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Justin F Fraser
- Department of Neurological Surgery, University of Kentucky, Lexington, KY, USA
| | - Justin Thomas DO
- Department of Neurosurgery, McLaren Northern Hospital, Petoskey, MI, USA
| | - Krishna Amuluru
- Interventional Neuroradiology, Goodman Campbell Brain and Spine, Indianapolis, IN, USA
| | - Louis J Kim
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Mark Harrigan
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Matthew R Amans
- Departments of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Max Kole
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
| | - Max Mokin
- Neurosurgery, University of South Florida, Tampa, FL, USA
| | - Michael Abraham
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mouhammad Jumaa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Nazli Janjua
- Asia Pacific Comprehensive Stroke Institute, Pomona Valley Hospital Medical Center, Pomona, CA, USA
| | - Osama Zaidat
- Department of Endovascular Neurosurgery, Mercy Health St Vincent Medical Center, Toledo, OH, USA
| | - Patrick P Youssef
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Priyank Khandelwal
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Qingliang Tony Wang
- Departments of Neurology/Neurosurgery, Maimonides Medical Center/SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City, UT, USA
| | - Ricardo Hanel
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, FL, USA
| | - Ryan T Kellogg
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | | | - Sunil Sheth
- Department of Neurology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston, MA, USA
| | - Viktor Szeder
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Yin C Hu
- Department of Neurosurgery, UH Cleveland Medical Center, Cleveland, OH, USA
| | - Albert J Yoo
- Department of Radiology/Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, TX, USA
| | - Omar Tanweer
- Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Jeremy J Heit
- Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA
| | - Richard Williamson
- Department of Neurological Surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Tareq Kass-Hout
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Richard W Crowley
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mohammad El-Ghanem
- Neuroendovascular Surgery, HCA Houston Northwest/University of Houston College of Medicine, Houston, TX, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
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Johnson MD, Ventre GJ, Kaye J, Patel HB, Naveed A, Prestigiacomo CJ, Ngwenya LB. Evaluating mortality and 6-month functional outcomes of patients with dural venous sinus thrombosis in traumatic brain injury. J Neurosurg 2023:1-10. [PMID: 38157533 DOI: 10.3171/2023.10.jns231158] [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: 05/22/2023] [Accepted: 10/12/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Patients with dural venous sinus thrombosis (DVST) in select populations following traumatic brain injury (TBI), including those with blunt mechanism or depressed skull fractures, have been shown to have an increased risk of mortality. The purpose of this study was to assess these findings in a mixed population of head trauma patients. METHODS The authors performed a case-control study using propensity score matching by reviewing 17 years (2004-2021) of data from their institutional trauma registry. Patients with imaging-confirmed DVST were matched to a control group of TBI patients without identified DVST based on age, sex, postresuscitation Glasgow Coma Scale (GCS) score, and Injury Severity Score. All age groups and injury mechanisms were included with a head Abbreviated Injury Scale score ≥ 3. Data on demographics, injury and radiographic characteristics, and patient outcomes were collected. Multivariable logistic regression was performed to identify predictors of inpatient mortality. An additional subgroup analysis of patients with concurrent DVST and blunt cerebrovascular injury (BCVI) was planned a priori. RESULTS The authors identified 9875 patients who presented to their institution over the study period with TBIs, with a 1.64% incidence of DVST. Concurrent BCVI was diagnosed in 23.5% of patients with a DVST. Following matching, the presence of DVST itself was not significantly associated with inpatient mortality (OR 0.68, 95% CI 0.24-1.88). On regression analysis, penetrating injuries (8.19, 95% CI 1.21-80.0) and lower postresuscitation GCS scores (0.69, 95% CI 0.53-0.84) were independently associated with inpatient mortality for patients with traumatic DVST. Significantly worse functional outcomes were observed in those with DVST at 3 months, with no significant difference at 6 months. CONCLUSIONS The authors observed a prevalence of traumatic DVST of 1.64% in a mixed population of head-injured patients, with 23.5% of patients with DVST having concurrent BCVI. Traumatic DVST alone was not associated with a significantly increased risk of inpatient mortality.
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Affiliation(s)
- Mark D Johnson
- 1College of Medicine, University of Cincinnati
- 2Department of Neurosurgery, University of Cincinnati; and
| | | | - Joel Kaye
- 1College of Medicine, University of Cincinnati
- 2Department of Neurosurgery, University of Cincinnati; and
| | | | - Asad Naveed
- 1College of Medicine, University of Cincinnati
- 2Department of Neurosurgery, University of Cincinnati; and
| | - Charles J Prestigiacomo
- 1College of Medicine, University of Cincinnati
- 2Department of Neurosurgery, University of Cincinnati; and
| | - Laura B Ngwenya
- 1College of Medicine, University of Cincinnati
- 3Department of Neurology & Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
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Hoz SS, Sharma M, Palmisciano P, Johnson MD, Ismail M, Muthana A, Al-Ageely TA, Forbes JA, Prestigiacomo CJ, Zuccarello M, Andaluz N. Peritrigeminal Safe Entry Zone Access to Anterolateral Pons Using the Presigmoid Retrolabyrinthine Suprameatal Approach: A Cadaveric Morphometric Study. Oper Neurosurg (Hagerstown) 2023; 25:e303-e307. [PMID: 37578224 DOI: 10.1227/ons.0000000000000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/01/2023] [Accepted: 06/09/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Access to the anterolateral pontine lesions can be achieved through the peritrigeminal and supratrigeminal safe entry zones using Kawase, retrosigmoid, or translabyrinthine approaches. However, these approaches entail shallow extensive dissection, tangential access, and compromise vestibulocochlear function. We aimed to investigate infratentorial presigmoid retrolabyrinthine approach to access pontine lesions through the peritrigeminal zone. METHODS We performed 10 presigmoid retrolabyrinthine suprameatal approach dissections in 5 cadaveric heads. Anatomic-radiological characteristics and variations were evaluated. Six morphometric parameters were measured and analyzed to predict surgical accessibility. RESULTS The pontine infratrigeminal area was accessible in all patients. The mean exposed area of the anterolateral pontine surface was 98.95 cm 2 (±38.11 cm 2 ). The mean length of the exposed trigeminal nerve was 7.9 cm (±2.9 cm). Preoperative anatomic-radiological parameters may allow to select patients with favorable anatomy that offers appropriate surgical accessibility to the anterior pontine cavernoma through a presigmoid retrolabyrinthine corridor. CONCLUSION Anterolateral pontine lesions can be accessed through a minimally invasive infratentorial presigmoid retrolabyrinthine approach by targeting the infratrigeminal safe entry zone. Further clinical studies should be conducted to evaluate the viability of this technique for treating these complex pathologies in real clinical settings.
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Affiliation(s)
- Samer S Hoz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Neurosurgery, Goodyear Microsurgery Lab, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mayur Sharma
- Department of Neurosurgery, Goodyear Microsurgery Lab, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Neurosurgery, Goodyear Microsurgery Lab, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mark D Johnson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Neurosurgery, Goodyear Microsurgery Lab, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mustafa Ismail
- Department of Neurosurgery, University of Baghdad College of Medicine, Baghdad, Iraq
| | - Ahmed Muthana
- Department of Neurosurgery, University of Baghdad College of Medicine, Baghdad, Iraq
| | - Teeba A Al-Ageely
- Department of Neurosurgery, University of Baghdad College of Medicine, Baghdad, Iraq
| | - Jonathan A Forbes
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Neurosurgery, Goodyear Microsurgery Lab, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Charles J Prestigiacomo
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Neurosurgery, Goodyear Microsurgery Lab, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mario Zuccarello
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Neurosurgery, Goodyear Microsurgery Lab, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Neurosurgery, Goodyear Microsurgery Lab, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Abbasi MH, Eltatawy A, Messé SR, Mowla A, Prestigiacomo CJ, Smith MS, Rosso M, Kasner SE, Shirani P. Basilar artery bifurcation anatomy as a determinant of recanalization and stroke outcome: Basilar artery bifurcation anatomy and stroke outcome. J Stroke Cerebrovasc Dis 2023; 32:107450. [PMID: 37924781 PMCID: PMC10872429 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107450] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023] Open
Abstract
OBJECTIVES Thrombectomy improves outcomes in patients with basilar artery (BA) occlusion. We hypothesized that the anatomic configuration of the BA bifurcation, classified as T- or Y-shaped, may impact the outcome as a T-shaped BA would involve more deep penetrating arteries of the midbrain and thalamus. MATERIALS AND METHODS In this 2-center retrospective cohort study, we included patients with stroke due to distal BA occlusion and performed blinded classification of their BA distal bifurcation as either T- or Y-shaped. The primary outcomes were favorable outcome at 90-days (modified Rankin Scale 0 - 2) and successful recanalization (TICI scores 2B or 3). RESULTS 70 patients (mean age 66 years, 36% women) were included. 38 had T- and 32 had Y-shaped bifurcations. Baseline characteristics were similar for both groups, including demographics, onset to arterial puncture time, baseline NIHSS, THRIVE score, posterior circulation collateral score, and presence of tandem occlusion. Comparing the T- to the Y- shape, there was no difference in the likelihood of successful recanalization (RR: 1.02, CI: [0.86-1.21], p=1.00) nor 90-day favorable mRS (0-2) score (RR: 0.58, CI: [0.25-1.32]; p=0.18). Similarly, mortality at 30 and 90-days were not significantly affected by the type of bifurcation. CONCLUSIONS The configuration of the basilar artery does not significantly impact on recanalization success or stroke outcome in our study. Further studies are needed to confirm our observations.
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Affiliation(s)
| | - Ali Eltatawy
- Department of Neurology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Steven R Messé
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ashkan Mowla
- Department of Neurological Surgery, University of Southern California, CA, USA
| | - Charles J Prestigiacomo
- Department of Neurological Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Matthew S Smith
- Department of Neurology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Michela Rosso
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Peyman Shirani
- Department of Neurology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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9
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Johnson MD, Prestigiacomo CJ. Preincisional Localization: An Overlooked Contribution by Ralph Bingham Cloward. World Neurosurg 2023; 179:37-42. [PMID: 37557981 DOI: 10.1016/j.wneu.2023.08.002] [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: 06/18/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
Preincisional localization has become ubiquitous within spinal neurosurgery and has served as the foundation for modern minimally invasive surgery techniques. Dr. Ralph Bingham Cloward, renowned for his contributions to the field of spinal fusion, was a strong advocate and early adopter of diskography. In fact, Cloward credited cervical diskography for inspiring his anterior approach to the cervical disk. In his landmark 1958 article on what is now known as anterior cervical diskectomy and fusion, Cloward commented on a case of wrong-level surgery that motivated him to implement a standardized technique for spinal level localization with the patient under anesthesia in the operating room before skin incision. We trace the origins of the use of preincisional radiographs to localize the pathologic level at the time of diskectomy and highlight this original contribution by Cloward.
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Affiliation(s)
- Mark D Johnson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
| | - Charles J Prestigiacomo
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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10
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Hoz SS, Palmisciano P, Albairmani SS, Kaye J, Muthana A, Johnson MD, Doyle EJ, Forbes JA, Prestigiacomo CJ, Samy R, Pensak ML, Zuccarello M, Andaluz N. A proposed classification system for presigmoid approaches: a scoping review. J Neurosurg 2023; 139:965-971. [PMID: 36905661 DOI: 10.3171/2023.2.jns222227] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/06/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE The "presigmoid corridor" covers a spectrum of approaches using the petrous temporal bone either as a target in treating intracanalicular lesions or as a route to access the internal auditory canal (IAC), jugular foramen, or brainstem. Complex presigmoid approaches have been continuously developed and refined over the years, leading to great heterogeneity in their definitions and descriptions. Owing to the common use of the presigmoid corridor in lateral skull base surgery, a simple anatomy-based and self-explanatory classification is needed to delineate the operative perspective of the different variants of the presigmoid route. Herein, the authors conducted a scoping review of the literature with the aim of proposing a classification system for presigmoid approaches. METHODS The PubMed, EMBASE, Scopus, and Web of Science databases were searched from inception to December 9, 2022, following the PRISMA Extension for Scoping Reviews guidelines to include clinical studies reporting the use of "stand-alone" presigmoid approaches. Findings were summarized based on the anatomical corridor, trajectory, and target lesions to classify the different variants of the presigmoid approach. RESULTS Ninety-nine clinical studies were included for analysis, and the most common target lesions were vestibular schwannomas (60/99, 60.6%) and petroclival meningiomas (12/99, 12.1%). All approaches had a common entry pathway (i.e., mastoidectomy) but were differentiated into two main categories based on their relationship to the labyrinth: translabyrinthine or anterior corridor (80/99, 80.8%) and retrolabyrinthine or posterior corridor (20/99, 20.2%). The anterior corridor comprised 5 variations based on the extent of bone resection: 1) partial translabyrinthine (5/99, 5.1%), 2) transcrusal (2/99, 2.0%), 3) translabyrinthine proper (61/99, 61.6%), 4) transotic (5/99, 5.1%), and 5) transcochlear (17/99, 17.2%). The posterior corridor consisted of 4 variations based on the target area and trajectory in relation to the IAC: 6) retrolabyrinthine inframeatal (6/99, 6.1%), 7) retrolabyrinthine transmeatal (19/99, 19.2%), 8) retrolabyrinthine suprameatal (1/99, 1.0%), and 9) retrolabyrinthine trans-Trautman's triangle (2/99, 2.0%). CONCLUSIONS Presigmoid approaches are becoming increasingly complex with the expansion of minimally invasive techniques. Descriptions of these approaches using the existing nomenclature can be imprecise or confusing. Therefore, the authors propose a comprehensive classification based on the operative anatomy that unequivocally describes presigmoid approaches simply, precisely, and efficiently.
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Affiliation(s)
| | | | | | | | - Ahmed Muthana
- 2University of Baghdad College of Medicine, Baghdad, Iraq
| | | | - Edward J Doyle
- 3Otolaryngology-Head and Neck Surgery, University of Cincinnati, Ohio; and
| | | | | | - Ravi Samy
- 3Otolaryngology-Head and Neck Surgery, University of Cincinnati, Ohio; and
| | - Myles L Pensak
- 3Otolaryngology-Head and Neck Surgery, University of Cincinnati, Ohio; and
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11
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Mistry EA, Hart KW, Davis LT, Gao Y, Prestigiacomo CJ, Mittal S, Mehta T, LaFever H, Harker P, Wilson-Perez HE, Beasley KA, Krothapalli N, Lippincott E, Stefek H, Froehler M, Chitale R, Fusco M, Grossman A, Shirani P, Smith M, Jaffa MN, Yeatts SD, Albers GW, Wanderer JP, Tolles J, Lindsell CJ, Lewis RJ, Bernard GR, Khatri P. Blood Pressure Management After Endovascular Therapy for Acute Ischemic Stroke: The BEST-II Randomized Clinical Trial. JAMA 2023; 330:821-831. [PMID: 37668620 PMCID: PMC10481231 DOI: 10.1001/jama.2023.14330] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/11/2023] [Indexed: 09/06/2023]
Abstract
Importance The effects of moderate systolic blood pressure (SBP) lowering after successful recanalization with endovascular therapy for acute ischemic stroke are uncertain. Objective To determine the futility of lower SBP targets after endovascular therapy (<140 mm Hg or 160 mm Hg) compared with a higher target (≤180 mm Hg). Design, Setting, and Participants Randomized, open-label, blinded end point, phase 2, futility clinical trial that enrolled 120 patients with acute ischemic stroke who had undergone successful endovascular therapy at 3 US comprehensive stroke centers from January 2020 to March 2022 (final follow-up, June 2022). Intervention After undergoing endovascular therapy, participants were randomized to 1 of 3 SBP targets: 40 to less than 140 mm Hg, 40 to less than 160 mm Hg, and 40 to 180 mm Hg or less (guideline recommended) group, initiated within 60 minutes of recanalization and maintained for 24 hours. Main Outcomes and Measures Prespecified multiple primary outcomes for the primary futility analysis were follow-up infarct volume measured at 36 (±12) hours and utility-weighted modified Rankin Scale (mRS) score (range, 0 [worst] to 1 [best]) at 90 (±14) days. Linear regression models were used to test the harm-futility boundaries of a 10-mL increase (slope of 0.5) in the follow-up infarct volume or a 0.10 decrease (slope of -0.005) in the utility-weighted mRS score with each 20-mm Hg SBP target reduction after endovascular therapy (1-sided α = .05). Additional prespecified futility criterion was a less than 25% predicted probability of success for a future 2-group, superiority trial comparing SBP targets of the low- and mid-thresholds with the high-threshold (maximum sample size, 1500 with respect to the utility-weighted mRS score outcome). Results Among 120 patients randomized (mean [SD] age, 69.6 [14.5] years; 69 females [58%]), 113 (94.2%) completed the trial. The mean follow-up infarct volume was 32.4 mL (95% CI, 18.0 to 46.7 mL) for the less than 140-mm Hg group, 50.7 mL (95% CI, 33.7 to 67.7 mL), for the less than 160-mm Hg group, and 46.4 mL (95% CI, 24.5 to 68.2 mL) for the 180-mm Hg or less group. The mean utility-weighted mRS score was 0.51 (95% CI, 0.38 to 0.63) for the less than 140-mm Hg group, 0.47 (95% CI, 0.35 to 0.60) for the less than 160-mm Hg group, and 0.58 (95% CI, 0.46 to 0.71) for the high-target group. The slope of the follow-up infarct volume for each mm Hg decrease in the SBP target, adjusted for the baseline Alberta Stroke Program Early CT score, was -0.29 (95% CI, -0.81 to ∞; futility P = .99). The slope of the utility-weighted mRS score for each mm Hg decrease in the SBP target after endovascular therapy, adjusted for baseline utility-weighted mRS score, was -0.0019 (95% CI, -∞ to 0.0017; futility P = .93). Comparing the high-target SBP group with the lower-target groups, the predicted probability of success for a future trial was 25% for the less than 140-mm Hg group and 14% for the 160-mm Hg group. Conclusions and Relevance Among patients with acute ischemic stroke, lower SBP targets less than either 140 mm Hg or 160 mm Hg after successful endovascular therapy did not meet prespecified criteria for futility compared with an SBP target of 180 mm Hg or less. However, the findings suggested a low probability of benefit from lower SBP targets after endovascular therapy if tested in a future larger trial. Trial Registration ClinicalTrials.gov Identifier: NCT04116112.
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Affiliation(s)
- Eva A. Mistry
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Kimberly W. Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Larry T. Davis
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yue Gao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Shilpi Mittal
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tapan Mehta
- Ayer Neuroscience Institute, Department of Neurology, Hartford Hospital, Hartford, Connecticut
| | - Hayden LaFever
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Pablo Harker
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | - Kalli A. Beasley
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Neeharika Krothapalli
- Ayer Neuroscience Institute, Department of Neurology, Hartford Hospital, Hartford, Connecticut
| | - Emily Lippincott
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Heather Stefek
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael Froehler
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rohan Chitale
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew Fusco
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aaron Grossman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Peyman Shirani
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Matthew Smith
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Matthew N. Jaffa
- Ayer Neuroscience Institute, Department of Neurology, Hartford Hospital, Hartford, Connecticut
| | - Sharon D. Yeatts
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | | | - Jonathan P. Wanderer
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Juliana Tolles
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, California
| | - Christopher J. Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
- Duke Clinical Research Institute, Durham, North Carolina
| | - Roger J. Lewis
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, California
- Statistical Editor, JAMA
| | - Gordon R. Bernard
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Pooja Khatri
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
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12
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Yamani AS, Johnson MD, Smith MS, Ngwenya LB, Prestigiacomo CJ. Post-traumatic Middle Meningeal Artery Pseudoaneurysm Treated With Endovascular Coil Embolization. Cureus 2023; 15:e45402. [PMID: 37854762 PMCID: PMC10581326 DOI: 10.7759/cureus.45402] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/20/2023] Open
Abstract
Pseudoaneurysms of the middle meningeal artery are rare events following head trauma. Given the potential for significant morbidity and mortality associated with pseudoaneurysm rupture, it is recommended that they be treated early. Endovascular embolization is a viable alternative to open surgical intervention. Here, we describe a case of an incidentally found middle meningeal artery pseudoaneurysm in a patient with a carotid-cavernous fistula after head injury. The pseudoaneurysm was treated with endovascular coil embolization.
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Affiliation(s)
- Ali S Yamani
- Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Mark D Johnson
- Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Matthew S Smith
- Neurology, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Laura B Ngwenya
- Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, USA
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13
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Palmisciano P, Hoz SS, Algburi HA, Ventre GJ, Street S, Agyeman N, Robinson M, Smith M, Shirani P, Grossman AW, Prestigiacomo CJ. 388 Percutaneous Transluminal Angioplasty and/or Stenting for the Treatment of Basilar Artery Stenosis: A Systematic Review and Meta-Analysis. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_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: 03/18/2023] Open
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14
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Palmisciano P, Hoz SS, Johnson MD, Forbes JA, Prestigiacomo CJ, Zuccarello M, Andaluz N. External Validation of an Extreme Gradient Boosting Model for Prediction of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2023:S1878-8750(23)00331-5. [PMID: 36914029 DOI: 10.1016/j.wneu.2023.03.036] [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: 11/10/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Delayed cerebral ischemia (DCI) may significantly worsen the functional status of patients with aneurysmal subarachnoid hemorrhage (aSAH). Several authors have designed predictive models for early identification of patients at risk of post-aSAH DCI. In this study, we externally validate an extreme gradient boosting (EGB) forecasting model for post-aSAH DCI prediction. METHODS A 9-year institutional retrospective review of patients with aSAH was performed. Patients were included if they underwent surgical or endovascular treatment and had available follow-up data. DCI was diagnosed as new onset neurological deficits at 4-12 days after aneurysm rupture, defined as worsening GCS for ≥2 points, and new ischemic infarcts at imaging. RESULTS 267 patients with aSAH were collected. At admission, median Hunt-Hess score was 2 (range, 1-5), median Fisher score 3 (range, 1-4), and median modified Fisher score 3 (range, 1-4). 145 patients underwent EVD placement for hydrocephalus (54.3%). The ruptured aneurysms were treated with clipping (64%), coiling (34.8%), and stent-assisted coiling (1.1%). 58 patients (21.7%) were diagnosed with clinical DCI and 82 (30.7%) with asymptomatic imaging vasospasm. The EGB classifier correctly predicted 19 cases of DCI (7.1%) and 154 cases of no-DCI (57.7%), achieving sensitivity of 32.76% and specificity of 73.68%. The calculated F1-score and accuracy were 0.288 and 64.8%, respectively. CONCLUSION We validated the EGB model has a potential assistant tool to predict post-aSAH DCI in clinical practice, finding moderate-high specificity but low sensitivity. Future research should investigate the underlying pathophysiology of DCI to allow the development of high-performing forecasting models.
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Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Samer S Hoz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mark D Johnson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jonathan A Forbes
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Charles J Prestigiacomo
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mario Zuccarello
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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15
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Palmisciano P, Hoz SS, Algburi HA, Ventre G, Street S, Agyeman N, Robinson MW, Smith MS, Shirani P, Grossman AW, Prestigiacomo CJ. Percutaneous transluminal angioplasty and/or stenting for the treatment of basilar artery stenosis: a systematic review and meta-analysis. Neuroradiology 2023; 65:985-1000. [PMID: 36881121 DOI: 10.1007/s00234-023-03124-x] [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: 10/09/2022] [Accepted: 01/14/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE Basilar artery stenosis (BAS) carries high morbidity and mortality, with variable outcomes after endovascular treatments. We systematically reviewed the literature on percutaneous transluminal angioplasty and/or stenting (PTAS) for BAS. METHODS PubMed, EMBASE, Web-of-Science, Scopus, and Cochrane were searched upon the PRISMA guidelines to include prospective/retrospective cohort studies describing PTAS for BAS. Pooled rates of intervention-related complications and outcomes were analyzed with random-effect model meta-analyses. RESULTS We included 25 retrospective cohort studies comprising 1016 patients. All patients were symptomatic, presenting with transient ischemic attack or ischemic stroke. BAS frequently involved the middle basilar artery (51.4%), mostly classified as Mori-B (57.4%). PTAS for BAS was indicated in severe (≥ 50-70%), symptomatic BAS refractory to dual antiplatelet therapy. Patients underwent angioplasty (95.5%) and/or stenting (92.2%), preferably using Wingspan or Apollo stents. Median baseline BAS was 81% (range, 53-99%), while median post-intervention BAS was 13% (0-75%). Actuarial rates of successful intervention and "good" final outcome were 100% (95% CI: 100-100%) and 89% (95% CI: 85-93%). Intervention-related recurrent ischemic stroke occurred in 85 patients (8.3%) with actuarial rates of 5% (95% CI: 4-7%), differentiated into perforator (5.4%), in-stent (2.6%), and embolic (0.4%). Actuarial rates of intervention-related dissection, restenosis, and death were 0% (95% CI: 0-0%), 1% (95% CI: 0-1%), and 0% (95% CI: 0-2%). CONCLUSION Elective PTAS appears to be safe and effective in selected patients with medically refractory, severe, symptomatic, and non-acute BAS. Different stent types and angioplasty-assisted procedures should be considered based on specific clinico-radiological characteristics of the lesions. Future randomized controlled trials are required to corroborate these findings.
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Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA
| | - Samer S Hoz
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA
| | | | - Giancarlo Ventre
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Seth Street
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nana Agyeman
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael W Robinson
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA
| | - Matthew S Smith
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Peyman Shirani
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Aaron W Grossman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Charles J Prestigiacomo
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA.
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16
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Prestigiacomo CJ. Commentary: A Sensorized Surgical Glove to Analyze Forces During Neurosurgery. Neurosurgery 2023; 92:e48-e49. [PMID: 36729636 DOI: 10.1227/neu.0000000000002311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
- Charles J Prestigiacomo
- Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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17
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Matur AV, Yamani AS, Robinson MW, Smith MS, Shirani P, Grossman AW, Prestigiacomo CJ. Association between underlying autoimmune disease and small aneurysm size at rupture. J Neurosurg 2023; 138:701-708. [PMID: 35901690 DOI: 10.3171/2022.5.jns22750] [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: 04/01/2022] [Accepted: 05/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although the role of inflammation in the development of aneurysms is established, less is known about the development of intracranial aneurysms in the setting of underlying autoimmune disease. The underlying systemic inflammatory characteristics of disorders such as systemic lupus erythematosus, rheumatoid arthritis, and Sjögren's syndrome may influence the development of intracranial aneurysms through common inflammatory pathways. The authors hypothesized that there is an association between underlying autoimmune disease and aneurysm growth and rupture. METHODS Medical records of patients who underwent cerebral angiography between August 2018 and August 2021 were manually reviewed. Autoimmune diseases as defined for this study are those known to have systemic inflammatory effects on the central nervous system or multiple other organ systems. Statistical analysis, including construction of multivariable linear and logistic regression models, was performed using R version 4.1.0. RESULTS Chart review identified 190 patients with 469 ruptured and unruptured saccular intracranial aneurysms. There were 31 patients with 44 aneurysms identified as having an autoimmune disease. The mean size of a ruptured aneurysm was significantly smaller among patients with autoimmune disease compared with patients without autoimmune disease (4.14 mm vs 5.34 mm, p = 0.03). The multivariate logistic regression model did not identify any significant association between rupture and autoimmune disease when controlling for other variables (p = 0.49). In the multivariate linear regression model, autoimmune disease was still significantly associated with a smaller size at rupture (p = 0.04), and smoking was associated with a larger size at rupture (p = 0.03) when controlling for other variables. A second multivariate logistic regression model found autoimmune disease to be independently associated with rupture at a size smaller than 7 mm (p = 0.02), while smoking was independently associated with rupture at a size larger than 7 mm (p = 0.01). CONCLUSIONS Autoimmune disease is associated with a smaller aneurysm size at rupture, although it is not associated with rupture itself. This association may be due to inflammatory pathways that are common to autoimmune diseases as well as aneurysm wall development. Although the authors were unable to identify any association between rupture status and the presence of autoimmune disease, the association between smaller size at rupture and autoimmune disease warrants further studies, as autoimmune disease may influence the trajectory of aneurysm development and the decision to treat.
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Affiliation(s)
- Abhijith V Matur
- 1Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati; and
| | - Ali S Yamani
- 1Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati; and
| | - Michael W Robinson
- 1Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati; and
| | - Matthew S Smith
- 2Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Peyman Shirani
- 2Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Aaron W Grossman
- 2Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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18
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Smith K, Ventre GJ, Palmisciano P, Hussein AE, Hoz SS, Forbes JA, Lowrie DJ, Zuccarello M, Andaluz N, Prestigiacomo CJ. Brain Vasculature Color-Labeling Using the Triple-Injection Method in Cadaveric Heads: A Technical Note for Improved Teaching and Research in Neurovascular Anatomy. Oper Neurosurg (Hagerstown) 2023; 24:291-300. [PMID: 36454090 DOI: 10.1227/ons.0000000000000495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/24/2022] [Accepted: 09/06/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Color-labeling injections of cadaveric heads have revolutionized education and teaching of neurovascular anatomy. Silicone-based and latex-based coloring techniques are currently used, but limitations exist because of the viscosity of solutions used. OBJECTIVE To describe a novel "triple-injection method" for cadaveric cranial vasculature and perform qualitative and semiquantitative evaluations of colored solution penetration into the vasculature. METHODS After catheter preparation, vessel cannulation, and water irrigation of embalmed cadaveric heads, food coloring, gelatin, and silicone solutions were injected in sequential order into bilateral internal carotid and vertebral arteries (red-colored) and internal jugular veins (blue-colored). In total, 6 triple-injected embalmed cadaveric heads and 4 silicone-based "control" embalmed cadaveric heads were prepared. A qualitative analysis was performed to compare the vessel coloring of 6 triple-injected heads with that of 4 "control" heads. A semiquantitative evaluation was completed to appraise sizes of the smallest color-filled vessels. RESULTS Naked-eye and microscope evaluations of embalmed experimental and control cadaveric heads revealed higher intensity and more distal color-labeling following the "triple-injection method" compared with the silicone-based method in both the intracranial and extracranial vasculature. Microscope assessment of 1-mm-thick coronal slices of triple-injected brains demonstrated color-filling of distal vessels with minimum diameters of 119 μm for triple-injected heads and 773 μm for silicone-based injected heads. CONCLUSION Our "triple-injection method" showed superior color-filling of small-sized vessels as compared with the silicone-based injection method, resulting in more distal penetration of smaller caliber vessels.
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Affiliation(s)
- Kathleen Smith
- Goodyear Microsurgery Anatomy Laboratory, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Giancarlo J Ventre
- Goodyear Microsurgery Anatomy Laboratory, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Paolo Palmisciano
- Goodyear Microsurgery Anatomy Laboratory, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ahmed E Hussein
- Goodyear Microsurgery Anatomy Laboratory, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Samer S Hoz
- Goodyear Microsurgery Anatomy Laboratory, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jonathan A Forbes
- Goodyear Microsurgery Anatomy Laboratory, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Donald J Lowrie
- Goodyear Microsurgery Anatomy Laboratory, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Medical Education, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mario Zuccarello
- Goodyear Microsurgery Anatomy Laboratory, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Norberto Andaluz
- Goodyear Microsurgery Anatomy Laboratory, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Charles J Prestigiacomo
- Goodyear Microsurgery Anatomy Laboratory, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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19
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Forbes JA, Kumar C, McGough D, Palmisciano P, Hussein AE, Zhebrykov D, Gibson J, Andaluz N, Sedaghat AR, Prestigiacomo CJ, Mendez-Rosito D, Virojanapa J, Phillips KM, Schwartz TH, Cheng JS. Anterior occipital condyle screw placement through the endonasal corridor: proof of concept study with cadaveric analysis. Eur Spine J 2023; 32:682-688. [PMID: 36593378 DOI: 10.1007/s00586-022-07520-4] [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] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 12/06/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Odontoidectomy for ventral compressive pathology may result in O-C1 and/or C1-2 instability. Same-stage endonasal C1-2 spinal fusion has been advocated to eliminate risks associated with separate-stage posterior approaches. While endonasal methods for C1 instrumentation and C1-2 trans-articular stabilization exist, no hypothetical construct for endonasal occipital instrumentation has been validated. We provide an anatomic description of anterior occipital condyle (AOC) screw endonasal placement as proof-of-concept for endonasal craniocervical stabilization. METHODS Eight adult, injected cadaveric heads were studied for placing 16 AOC screws endonasally. Thin-cut CT was used for registration. After turning a standard inferior U-shaped nasopharyngeal flap endonasally, 4 mm × 22 mm AOC screws were placed with a 0° driver using neuronavigation. Post-placement CT scans were obtained to determine: site-of-entry, measured from the endonasal projection of the medial O-C1 joint; screw angulation in sagittal and axial planes, proximity to critical structures. RESULTS Average site-of-entry was 6.88 mm lateral and 9.74 mm rostral to the medial O-C1 joint. Average angulation in the sagittal plane was 0.16° inferior to the palatal line. Average angulation in the axial plane was 23.97° lateral to midline. Average minimum screw distances from the jugular bulb and hypoglossal canal were 4.80 mm and 1.55 mm. CONCLUSION Endonasal placement of AOC screws is feasible using a 0° driver. Our measurements provide useful parameters to guide optimal placement. Given proximity of hypoglossal canal and jugular bulb, neuronavigation is recommended. Biomechanical studies will ultimately be necessary to evaluate the strength of AOC screws with plate-screw constructs utilizing endonasal C1 lateral mass or C1-2 trans-articular screws as inferior fixation points.
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Affiliation(s)
- Jonathan A Forbes
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA.
| | - Chitra Kumar
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Dan McGough
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA
| | - Ahmed E Hussein
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA
| | - Dmytro Zhebrykov
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA
| | - Justin Gibson
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology and Head and Neck, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Charles J Prestigiacomo
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA
| | - Diego Mendez-Rosito
- Department of Neurological Surgery, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | - Justin Virojanapa
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA
| | - Katie M Phillips
- Department of Otolaryngology and Head and Neck, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Theodore H Schwartz
- Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Joseph S Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA
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20
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Hoz SS, Abdulsada AM, Ismail M, Alfawares Y, Forbes JA, Prestigiacomo CJ, Andaluz N. The functional anatomy of the foramina of Luschka revisited. Surg Neurol Int 2022; 13:512. [DOI: 10.25259/sni_931_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Background:
The German Anatomist Hubert Von Luschka first described the foramina of Luschka (FOL) in 1855 as lateral holes in the fourth ventricle. By his discovery, he refuted previous beliefs about the lateral recess as blind ends of the fourth ventricle, proving the continuity of the ventricular system with the central canal of the spinal cord. In this paper, we question the outline variations of the patent parts of FOL and their consistency, drawing attention to the apparent query of the valvular mechanism of FOL.
Methods:
We conducted a literature review in PubMed and Google Scholar databases to review the existing literature describing the history, pertinent anatomy, and function of FOL. In addition, we reviewed the original German book written by Luschka.
Results:
While reading the available articles and original works regarding FOL, we noticed the developmental phases through which FOL was discovered, tracking the process from Aristotle till Luschka’s discovery. We also discussed controversies and opinions about FOL’s existence and function.
Conclusion:
FOL is halved into two compartments: choroidal and patent. The function of FOL resembles a oneway valve mechanism, and it depends on the patent slit-like part. Luschka had discovered over 20 anatomical structures, including several foramina, confusion in a debate may result from eponyms.
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Affiliation(s)
- Samer S. Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States,
| | | | - Mustafa Ismail
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq
| | - Yara Alfawares
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States,
| | - Jonathan A. Forbes
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States,
| | | | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States,
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21
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Forbes JA, Palmisciano P, McGough D, Kumar C, Hussein AE, Slobodyan A, Kaye J, Matur AV, McGuire JL, Andaluz N, Phillips KM, Prestigiacomo CJ, Ashghar F, Virojanapa J, Cheng JS. C1 Lateral Mass Screw Placement Through Endonasal Corridor for Purpose of O-C1 Fusion: Morphometric Analysis in Cadaveric Specimens. World Neurosurg 2022; 167:e614-e619. [PMID: 36007772 DOI: 10.1016/j.wneu.2022.08.061] [Citation(s) in RCA: 1] [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: 06/27/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Odontoidectomy may pose some risks for O-C1 and/or C1-C2 instability, with previous authors reporting techniques for endonasal C1-C2 fusion. However, no technique for endonasal O-C1 fusion currently exists. We sought to describe the feasibility of endonasal anterior C1 (AC1) screw placement for endonasal O-C1 fusion. METHODS Seven adult cadaveric heads were studied for endonasal placement of 14 C1 screws. Using thin-cut computed tomography (CT)-based "snapshot" neuronavigation assistance, 4 mm x 22 mm screws were placed in the C1 lateral mass using a 0° driver. Post-placement CT scans were obtained to determine site-of-entry measured from C1 anterior tubercle, screw angulation in axial and sagittal planes, and screw proximity to the central canal and foramen transversarium. RESULTS Average site-of-entry was 16.57 mm lateral, 2.23 mm rostral, and 5.53 mm deep to the anterior-most portion of the C1 ring. Average axial angulation was 19.49° lateral to midline, measured at the C1 level. Average sagittal angulation was 13.22° inferior to the palatal line, measured from the hard palate to the opisthion. Bicortical purchase was achieved in 11 screws (78.6%). Partial breach of the foramen transversarium was observed in 2 screws (14.3%), violation of the O-C1 joint space in 1 (7.1%), and violation of the central canal in 0 (0%). Average minimum screw distances from the unviolated foramen transversaria and central canal were 1.97 mm and 4.04 mm. CONCLUSIONS Navigation-assisted endonasal placement of AC1 screws is feasible. Additional studies should investigate the biomechanical stability of anterior C1 screw-plating systems, with anterior condylar screws as superior fixation point, compared to traditional posterior O-C1 fusion.
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Affiliation(s)
- Jonathan A Forbes
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daniel McGough
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Chitra Kumar
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ahmed E Hussein
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alesia Slobodyan
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joel Kaye
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Abhijith V Matur
- Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
| | - Jennifer L McGuire
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katie M Phillips
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Charles J Prestigiacomo
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ferhan Ashghar
- Department of Orthopedic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Justin Virojanapa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joseph S Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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22
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Alfawares Y, Folz C, Johnson MD, Prestigiacomo CJ, Ngwenya LB. The history of antibiotic irrigation and prophylaxis in operative neurotrauma: perpetuation of military care in civilian settings. Neurosurg Focus 2022; 53:E7. [DOI: 10.3171/2022.6.focus22253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/21/2022] [Indexed: 11/06/2022]
Abstract
The benefit of antibiotic irrigation for prophylaxis against wound infections, not only for traumatic cranial injuries but also in elective neurosurgical care, has recently been called into question. Several articles have cast doubt on the utility of topical antibiotics, and recently, bacitracin irrigation was made unavailable in some US markets. The pervasive nature of antibiotic irrigation, considering the lack of evidence supporting its use, led the authors to question when and how neurosurgeons started using antibiotic irrigation in cranial neurosurgery. Through a review of historical literature, they highlight the adoption of antibiotic irrigation as it began in battlefield surgical practice, gradually leading to the modern concept of antibiotic prophylaxis in civilian and military care.
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Affiliation(s)
| | | | - Mark D. Johnson
- College of Medicine, University of Cincinnati
- Department of Neurosurgery, University of Cincinnati; and
| | - Charles J. Prestigiacomo
- College of Medicine, University of Cincinnati
- Department of Neurosurgery, University of Cincinnati; and
| | - Laura B. Ngwenya
- College of Medicine, University of Cincinnati
- Department of Neurosurgery, University of Cincinnati; and
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, Ohio
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23
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Prestigiacomo CJ, Preul MC, Dagi TF, Neal CJ, Rosenfeld JV, Meister M. Introduction. On forging a new specialty from the crucible of war. Neurosurg Focus 2022; 53:E1. [PMID: 36052617 DOI: 10.3171/2022.7.focus22375] [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: 01/25/2023]
Affiliation(s)
- Charles J Prestigiacomo
- 1Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mark C Preul
- 2Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
| | - T Forcht Dagi
- 3Department of Neurological Surgery, Mayo College of Medicine and Science, Rochester, Minnesota
| | - Chris J Neal
- 4Division of Neurological Surgery, Walter Reed Medical Center, Bethesda, Maryland; and
| | - Jeffrey V Rosenfeld
- 5Department of Neurosurgery, Alfred Hospital, Melbourne, Victoria, Australia
| | - Melissa Meister
- 4Division of Neurological Surgery, Walter Reed Medical Center, Bethesda, Maryland; and
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24
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De Leacy R, Ansari SA, Schirmer CM, Cooke DL, Prestigiacomo CJ, Bulsara KR, Hetts SW. Endovascular treatment in the multimodality management of brain arteriovenous malformations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee. J Neurointerv Surg 2022; 14:1118-1124. [PMID: 35414599 DOI: 10.1136/neurintsurg-2021-018632] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 01/13/2022] [Accepted: 03/07/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purpose of this review is to summarize the data available for the role of angiography and embolization in the comprehensive multidisciplinary management of brain arteriovenous malformations (AVMs METHODS: We performed a structured literature review for studies examining the indications, efficacy, and outcomes for patients undergoing endovascular therapy in the context of brain AVM management. We graded the quality of the evidence. Recommendations were arrived at through a consensus conference of the authors, then with additional input from the full Society of NeuroInterventional Surgery (SNIS) Standards and Guidelines Committee and the SNIS Board of Directors. RESULTS The multidisciplinary evaluation and treatment of brain AVMs continues to evolve. Recommendations include: (1) Digital subtraction catheter cerebral angiography (DSA)-including 2D, 3D, and reformatted cross-sectional views when appropriate-is recommended in the pre-treatment assessment of cerebral AVMs. (I, B-NR) . (2) It is recommended that endovascular embolization of cerebral arteriovenous malformations be performed in the context of a complete multidisciplinary treatment plan aiming for obliteration of the AVM and cure. (I, B-NR) . (3) Embolization of brain AVMs before surgical resection can be useful to reduce intraoperative blood loss, morbidity, and surgical complexity. (IIa, B-NR) . (4) The role of primary curative embolization of cerebral arteriovenous malformations is uncertain, particularly as compared with microsurgery and radiosurgery with or without adjunctive embolization. Further research is needed, particularly with regard to risk for AVM recurrence. (III equivocal, C-LD) . (5) Targeted embolization of high-risk features of ruptured brain AVMs may be considered to reduce the risk for recurrent hemorrhage. (IIb, C-LD) . (6) Palliative embolization may be useful to treat symptomatic AVMs in which curative therapy is otherwise not possible. (IIb, B-NR) . (7) The role of AVM embolization as an adjunct to radiosurgery is not well-established. Further research is needed. (III equivocal, C-LD) . (8) Imaging follow-up after apparent cure of brain AVMs is recommended to assess for recurrence. Although non-invasive imaging may be used for longitudinal follow-up, DSA remains the gold standard for residual or recurrent AVM detection in patients with concerning imaging and/or clinical findings. (I, C-LD) . (9) Improved national and international reporting of patients of all ages with brain AVMs, their treatments, side effects from treatment, and their long-term outcomes would enhance the ability to perform clinical trials and improve the rigor of research into this rare condition. (I, C-EO) . CONCLUSIONS Although the quality of evidence is lower than for more common conditions subjected to multiple randomized controlled trials, endovascular therapy has an important role in the management of brain AVMs. Prospective studies are needed to strengthen the data supporting these recommendations.
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Affiliation(s)
- Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sameer A Ansari
- Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Daniel L Cooke
- Radiology and Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | | | - Ketan R Bulsara
- Division of Neurosurgery, University of Connecticut, Farmington, Connecticut, USA
| | - Steven W Hetts
- Radiology and Biomedical Imaging, University California San Francisco, San Francisco, California, USA
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25
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Matur AV, Body AM, Johnson MD, Smith MS, Bhabhra R, Lester EJ, Stahl TL, Grossman AW, Shirani P, Forbes JA, Prestigiacomo CJ. An algorithm to improve lateralization accuracy of inferior petrosal sinus sampling: procedural nuances for complex patterns of venous drainage. Patient series. Journal of Neurosurgery: Case Lessons 2021; 2:CASE21374. [PMID: 35854787 PMCID: PMC9265235 DOI: 10.3171/case21374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/19/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Inferior petrosal sinus sampling (IPSS) is a useful technique in the diagnosis of Cushing’s disease (CD) when the imaging finding is negative or equivocal. Different authors have reported considerable variability in the ability to determine tumor laterality with IPSS. Here the authors present a retrospective case series of 7 patients who underwent IPSS using a systematic algorithm to improve lateralization accuracy by identifying optimal sampling sites on the basis of individual cavernous sinus drainage patterns in each patient.
OBSERVATIONS
Of the 7 patients identified, 6 were determined to have CD and subsequently underwent surgery. IPSS was accurate in all patients from whom laterality was predicted. Arterial and venous angiography were used to define cavernous sinus drainage patterns and determine optimal sampling sites. All patients who underwent surgery achieved hormonal cure.
LESSONS
All IPSS predictions of lateralization were correct when available, and all patients who underwent surgery achieved hormonal cure. Advances in angiographic techniques for identification of the site of primary drainage from the cavernous sinus and subsequent optimization of microcatheter placement may improve the ability to predict tumor laterality.
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Affiliation(s)
- Abhijith V. Matur
- Department of General Surgery, University of Kentucky College of Medicine, Lexington, Kentucky; and
| | | | | | | | | | - Emily J. Lester
- Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Trisha L. Stahl
- Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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26
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Kaye JM, Mejia-Munne JC, Grossman AW, Shirani P, Smith MS, Prestigiacomo CJ. Stenting in High-Grade Internal Carotid Artery Stenosis: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E128. [PMID: 33930171 DOI: 10.1093/ons/opab125] [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: 11/09/2020] [Accepted: 02/23/2021] [Indexed: 11/12/2022] Open
Abstract
Carotid artery stenosis is implicated in up to 40% of all ischemic strokes. Accordingly, symptomatic, high-grade carotid artery stenosis portends an especially high risk of future stroke. Intervention via open or endovascular approaches drastically reduces this risk. Under the appropriate conditions, carotid artery stenting serves as a safe and effective alternative to carotid endarterectomy. We present the case of a 57-yr-old male with symptomatic, high-grade stenosis of his right internal carotid artery, for whom a history of radiation to the head and neck represented a relative contraindication to carotid endarterectomy, and thus endovascular treatment with angioplasty and stenting was performed. Informed consent was obtained prior to the procedure. Intraprocedurally, stent delivery past the area of stenosis proved somewhat challenging. However, by employing several nuanced maneuvers, we utilized our guiding catheter in a nonconventional manner in order to successfully perform the procedure. As the field of neuroendovascular surgery evolves, each case provides us unique lessons, which in turn expands our interventional capabilities and adds to the armamentarium of neuroendovascular techniques. We present this surgical video both as a means to provide a general overview of carotid artery stenting, and to share a lesson learned through the implementation of an interesting technical nuance.
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Affiliation(s)
- Joel M Kaye
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Juan C Mejia-Munne
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Aaron W Grossman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Peyman Shirani
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Matthew S Smith
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Charles J Prestigiacomo
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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27
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Body AM, Plummer ZJ, Krueger BM, Virojanapa J, Nasser R, Cheng JS, Prestigiacomo CJ. Retrograde ejaculation following anterior lumbar surgery: a systematic review and pooled analysis. J Neurosurg Spine 2021; 35:427-436. [PMID: 34271542 DOI: 10.3171/2020.12.spine201101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The present systematic review and pooled analysis aims to assess the incidence and risk factors for the development of retrograde ejaculation (RE) following first-time open anterior lumbar surgery. METHODS A systematic MEDLINE review via PubMed was performed, identifying 130 clinical papers relating to the topic. Eighteen publications were selected according to predetermined inclusion and exclusion criteria and were used to determine the incidence of RE. Only the publications that provided data on surgical risk factors present specifically in the men in the study were included in the analysis of risk factors. RESULTS Of the 2503 men included, there were 57 reported events of RE (2.3%). Of the cases for which long-term data were provided, 45.8% had resolved by final follow-up. There was a statistically significant increased risk associated with a transperitoneal as opposed to a retroperitoneal approach (8.6% vs 3.2%), as well as with the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in anterior lumbar interbody fusion (ALIF) as opposed to ALIF with bone graft or arthroplasty in controls (5.0% vs 1.8%). However, when excluding from analysis the patients operated on prior to the FDA's 2008 warning that commented on the drug's neuroinflammatory properties, there was no significant difference in rates of RE in patients receiving rhBMP-2 versus the control group (2.4% vs 2.5%). There was no significant difference in risk based on single- versus multilevel procedure or on ALIF versus arthroplasty. CONCLUSIONS In a pooled analysis of currently published data on men undergoing first-time open anterior lumbar surgery, this study found an overall incidence of RE of 2.3%. Nearly half of these patients recovered, reporting resolution of symptoms anywhere between 3 months and 48 months. Analysis of risk factors was limited by a paucity of published literature segregating data by sex. However, there was an increased risk associated with rhBMP-2 only when including data collected prior to the FDA warning on its detrimental properties. The authors therefore posit that the risk of RE is probably overestimated in the literature, given that the vast majority of the data available were collected prior to this warning and given the subsequent implementation of precautions when handling rhBMP-2.
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28
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Robinson MW, Prestigiacomo CJ, Ngwenya LB. Commentary: Intracerebral Hemorrhage Volume Reduction and Timing of Intervention Versus Functional Benefit and Survival in the MISTIE III and STICH Trials. Neurosurgery 2021; 88:E394-E395. [PMID: 33556176 DOI: 10.1093/neuros/nyab018] [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] [Received: 12/06/2020] [Accepted: 12/11/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michael W Robinson
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Laura B Ngwenya
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA.,Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Prestigiacomo CJ. Editorial. Myths, misquotes, and the perpetuation of errors through the published literature: the double-edged sword of progress. J Neurosurg 2021:1-3. [PMID: 33990088 DOI: 10.3171/2020.11.jns203624] [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: 11/06/2022]
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Prestigiacomo CJ. Commentary: The Use of Antiplatelet Agents and Heparin in the 24-Hour Postintravenous Alteplase Window for Neurointervention. Neurosurgery 2021; 88:E308-E309. [PMID: 33517443 DOI: 10.1093/neuros/nyaa546] [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] [Received: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Charles J Prestigiacomo
- Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Neurovascular and Endovascular Neurosurgery, Comprehensive Stroke Center, University of Cincinnati Medical Center, Cincinnati, Ohio
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Fargen KM, Lee SK, Mokin M, Kayan Y, De Leacy R, Al-Mufti F, Ansari SA, Haranhalli N, Prestigiacomo CJ, Schirmer CM, Fraser JF, Hetts SW. Social media usage for neurointerventionalists: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee. J Neurointerv Surg 2021; 13:674-678. [PMID: 33722972 DOI: 10.1136/neurintsurg-2021-017278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/04/2021] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 11/03/2022]
Abstract
The purpose of this publication is to provide a review of social media usage by neurointerventionalists. Using published literature and available local, regional, and national guidelines or laws, we reviewed data on social media usage as it pertains to neurointerventional surgery. Recommendations are provided based on the quality of information and conformity of medico-legal precedent and law. Social media is a growing entity as it is used both promotionally and educationally. Neurointerventionalists may post de-identified radiographic images with discussions, but should be conscientious and adhere to applicable laws and regulations, strict ethical codes, and institutional policies.
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Affiliation(s)
- Kyle M Fargen
- Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Seon-Kyu Lee
- Radiology, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | - Maxim Mokin
- Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Yasha Kayan
- Interventional Neuroradiology, Abbot Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fawaz Al-Mufti
- Neurology and Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Sameer A Ansari
- Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Neil Haranhalli
- Neurosurgery, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | | | | | - Justin F Fraser
- Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Steven W Hetts
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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32
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Sayles E, Hsiao J, Sucharew H, Antzoulatos E, Stanton RJ, Broderick JP, Kircher C, Peariso K, Demel SL, Flaherty ML, Grossman AW, Prestigiacomo CJ, Kreitzer N, Shirani P, Walsh KB, Lampton H, Khatri P, Adeoye O. Abstract P121: Update on Regional Stroke Activation Trends During Covid-19 Mitigation. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The University of Cincinnati Stroke Team provides acute stroke care to the southwest Ohio, northern Kentucky, and southeast Indiana catchment area of ~2 million people and 30 healthcare facilities. We previously published a significant decline in stroke activations and reperfusion treatment (IV thrombolysis and EVT) rates following state announcements of COVID-19 mitigation measures. Here, we update these trends after state reopening guidelines.
Methods:
We compared Stroke Team activations and reperfusion treatments logged in a prospectively collected database, comparing the same period in 2020 versus 2019. Kentucky and Ohio announced school and restaurant closures on March 12 and 13, respectively, followed by Indiana. A stepwise reopening of our tristate area started on May 1, 2020. We also compared trends in activations and treatment rates before (Weeks 1-10), during (Weeks 11-17), and after (Weeks 18-26) the lifting of COVID-19 mitigation efforts using the Poisson test, and graphically with segmented regression analysis.
Results:
Compared to 2019, stroke team activations declined by 12% in 2020 (95% CI 7 - 16%; p<0.01). During 2020, an initial decline in stroke activations following COVID-19 mitigation announcements was followed by a 28% increase in activations after reopening (Weeks 18-26: 95% CI 15 - 42%; p<0.01). In contrast, compared to 2019, treatment rates were unchanged (0%, 95% CI -15 - 18%; p=1.00), including specifically IV thrombolysis and thrombectomy rates. Similarly, an initial decline in reperfusion treatments was followed by a 24% nonsignificant increase after reopening (95% CI -10 - 71%; p=0.19) in 2020.
Conclusion:
The initial decline in stroke team activations during COVID-19 mitigation efforts was followed by an increase in activations after reopening. Hospital capacity and 911 services remained fully intact, suggesting that the reduction in activations were related to reduced presentation by patients for emergent stroke care.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Holly Lampton
- Dept of Communications, Hamilton County, Cincinnati, OH
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Hussein A, Prestigiacomo CJ. On Calculating the Elastic Properties of Cerebral Aneurysms Through Cardiac-Gated Imaging. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_321] [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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34
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Matur AV, Ngwenya LB, Prestigiacomo CJ. The surgical history of head injury in motor vehicle collision. J Neurosurg 2020:1-7. [PMID: 33254132 DOI: 10.3171/2020.7.jns20941] [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: 03/26/2020] [Accepted: 07/06/2020] [Indexed: 11/06/2022]
Abstract
Motor vehicle collisions (MVCs) are a significant cause of head injuries today, but efforts to manage and prevent these injuries extend as far back as the beginning of modern neurosurgery itself. Head trauma in MVCs occurred as far back as 1899, and the surgical literature of the time mentions several cases of children being struck by passing automobiles. By the 1930s, Dr. Claire L. Straith, a Detroit plastic surgeon, recommended changes to automobile design after seeing facial injuries and depressed skull fractures that resulted from automobile accidents. During World War II, Sir Hugh Cairns, a British neurosurgeon, demonstrated the efficacy of motorcycle helmets in preventing serious head injury. In the 1950s, Dr. Frank H. Mayfield, a Cincinnati neurosurgeon on the trauma committee of the American College of Surgeons, made several recommendations, such as adding padded dashboards and seatbelts, to make automobiles safer. Ford implemented the recommendations from Dr. Mayfield and others into a safety package for the 1956 models. Significant work has also been done to prevent head injury in motorsports. Efforts by surgeons, especially neurosurgeons, to prevent head injury in MVCs have saved countless lives, although it is a less frequently celebrated achievement.
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Affiliation(s)
| | - Laura B Ngwenya
- 1University of Cincinnati College of Medicine and
- Departments of2Neurosurgery and
- 3Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
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35
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Le DT, Barhorst KA, Castiglione J, Yang GL, Shah SJ, Harlan SS, Keegan SP, Jandarov RA, Ngwenya LB, Prestigiacomo CJ. Blunt cerebrovascular injury in the geriatric population. Neurosurg Focus 2020; 49:E10. [PMID: 33002862 DOI: 10.3171/2020.7.focus20499] [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: 05/31/2020] [Accepted: 07/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Blunt cerebrovascular injury (BCVI) is associated with high rates of neurological morbidity and mortality. The detection and management of BCVI has improved with advances in imaging and sensitive screening protocols. Few studies have explored how these injuries specifically affect the geriatric population. The purpose of this retrospective analysis was to investigate the presentation and prognosis of BCVI in the elderly population and to assess its clinical implications in the management of these patients. METHODS All patients presenting to the University of Cincinnati (UC) level I trauma center between February 2017 and December 2019 were screened for BCVI and entered into the prospectively maintained UC Neurotrauma Registry. Patients with BCVI confirmed by CT angiography underwent retrospective chart reviews to collect information regarding demographics, positive screening criteria, cause of injury, antithrombotic agent, injury location, Denver Grading Scale, hospital and ICU length of stay, and discharge disposition. Patients were divided into geriatric (age ≥ 65 years) and adult (age < 65 years) subgroups. Continuous variables were analyzed using the Student t-test and categorical variables with the Pearson chi-square test. RESULTS Of 124 patients with BCVI, stratification by age yielded 23 geriatric and 101 adult patients. Injury in the geriatric group was associated with significantly higher mortality (p = 0.0194). The most common cause of injury in the elderly was falls (74%, 17/23; p < 0.0001), whereas motor vehicle accidents were most common in the adult group (38%, 38/100; p = 0.0642). With respect to the location of injury, carotid (p = 0.1171) and vertebral artery (p = 0.6981) injuries did not differ significantly for the geriatric group. The adult population presented more often with Denver grade I injuries (p < 0.0001), whereas the geriatric population presented with grade IV injuries (p = 0.0247). Elderly patients were more likely to be discharged to skilled nursing facilities (p = 0.0403) and adults to home or self-care (p = 0.0148). CONCLUSIONS This study is the first to characterize BCVI to all cervical and intracranial vessels in the geriatric population. Older age at presentation is significantly associated with greater severity, morbidity, and mortality from injury, with no preference for the particular artery injured. These findings carry important clinical implications for adapting practice in an aging population.
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Affiliation(s)
- Diana T Le
- 1University of Cincinnati College of Medicine
| | | | | | - George L Yang
- 2Department of Neurological Surgery, University of Cincinnati College of Medicine
| | - Sanjit J Shah
- 2Department of Neurological Surgery, University of Cincinnati College of Medicine
| | - Sarah S Harlan
- 3Division of Pharmaceutical Sciences, James L. Winkle College of Pharmacy, University of Cincinnati; and
| | - Shaun P Keegan
- 3Division of Pharmaceutical Sciences, James L. Winkle College of Pharmacy, University of Cincinnati; and
| | - Roman A Jandarov
- 4Division of Biostatistics and Bioinformatics, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Laura B Ngwenya
- 2Department of Neurological Surgery, University of Cincinnati College of Medicine
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36
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Mau C, Wassef CE, Sabourin V, Gandhi CD, Prestigiacomo CJ. The Life and Death of Lord Nelson: The Leader, the Patient, the Legend. World Neurosurg 2020; 145:348-355. [PMID: 32992067 DOI: 10.1016/j.wneu.2020.09.122] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 11/20/2022]
Abstract
Admiral Lord Horatio Nelson is perhaps the most renowned naval commander, who allowed Britain to have dominion over the sea for 100 years after his victory at the Battle of Trafalgar. He was able to do so despite suffering from a multitude of communicable diseases and traumatic injuries, including the functional loss of his right eye, amputation of his right arm, scalp laceration, head injury, and finally a spinal injury. These injuries had permanent consequences but did not stop him from leading the charge and allowing the British to defeat the French and Spanish fleets in the decisive Battle of Trafalgar.
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Affiliation(s)
- Christine Mau
- Department of Neurological Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Catherine E Wassef
- Department of Neurological Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Victor Sabourin
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Chirag D Gandhi
- Department of Neurological Surgery, Westchester Medical Center, Valhalla, New York, USA
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37
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Hsiao J, Sayles E, Antzoulatos E, Stanton RJ, Sucharew H, Broderick JP, Demel SL, Flaherty ML, Grossman AW, Kircher C, Kreitzer N, Peariso K, Prestigiacomo CJ, Shirani P, Walsh KB, Lampton H, Adeoye O, Khatri P. Effect of COVID-19 on Emergent Stroke Care: A Regional Experience. Stroke 2020; 51:e2111-e2114. [PMID: 32639860 PMCID: PMC7359904 DOI: 10.1161/strokeaha.120.030499] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/17/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE Anecdotal evidence suggests that the coronavirus disease 2019 (COVID-19) pandemic mitigation efforts may inadvertently discourage patients from seeking treatment for stroke with resultant increased morbidity and mortality. Analysis of regional data, while hospital capacities for acute stroke care remained fully available, offers an opportunity to assess this. We report regional Stroke Team acute activations and reperfusion treatments during COVID-19 mitigation activities. METHODS Using case log data prospectively collected by a Stroke Team exclusively serving ≈2 million inhabitants and 30 healthcare facilities, we retrospectively reviewed volumes of consultations and reperfusion treatments for acute ischemic stroke. We compared volumes before and after announcements of COVID-19 mitigation measures and the prior calendar year. RESULTS Compared with the 10 weeks prior, stroke consultations declined by 39% (95% CI, 32%-46%) in the 5 weeks after announcement of statewide school and restaurant closures in Ohio, Kentucky, and Indiana. Results compared with the prior year and time trend analyses were consistent. Reperfusion treatments also appeared to decline by 31% (95% CI, 3%-51%), and specifically thrombolysis by 33% (95% CI, 4%-55%), but this finding had less precision. CONCLUSIONS Upon the announcement of measures to mitigate COVID-19, regional acute stroke consultations declined significantly. Reperfusion treatment rates, particularly thrombolysis, also appeared to decline qualitatively, and this finding requires further study. Urgent public education is necessary to mitigate a possible crisis of avoiding essential emergency care due to COVID-19.
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Affiliation(s)
- Jessica Hsiao
- Department of Neurology (J.H., E.S., E.A., R. J. S., J.P.B., S. L. D., M.L.F., A. W. G., P.S., P.K.), University of Cincinnati, OH
| | - Emily Sayles
- Department of Neurology (J.H., E.S., E.A., R. J. S., J.P.B., S. L. D., M.L.F., A. W. G., P.S., P.K.), University of Cincinnati, OH
| | - Eleni Antzoulatos
- Department of Neurology (J.H., E.S., E.A., R. J. S., J.P.B., S. L. D., M.L.F., A. W. G., P.S., P.K.), University of Cincinnati, OH
| | - Robert J. Stanton
- Department of Neurology (J.H., E.S., E.A., R. J. S., J.P.B., S. L. D., M.L.F., A. W. G., P.S., P.K.), University of Cincinnati, OH
| | - Heidi Sucharew
- Division of Biostatistics (H.S.), Cincinnati Children’s Hospital Medical Center, OH
| | - Joseph P. Broderick
- Department of Neurology (J.H., E.S., E.A., R. J. S., J.P.B., S. L. D., M.L.F., A. W. G., P.S., P.K.), University of Cincinnati, OH
| | - Stacie L. Demel
- Department of Neurology (J.H., E.S., E.A., R. J. S., J.P.B., S. L. D., M.L.F., A. W. G., P.S., P.K.), University of Cincinnati, OH
| | - Matthew L. Flaherty
- Department of Neurology (J.H., E.S., E.A., R. J. S., J.P.B., S. L. D., M.L.F., A. W. G., P.S., P.K.), University of Cincinnati, OH
| | - Aaron W. Grossman
- Department of Neurology (J.H., E.S., E.A., R. J. S., J.P.B., S. L. D., M.L.F., A. W. G., P.S., P.K.), University of Cincinnati, OH
| | - Charles Kircher
- Department of Emergency Medicine (C.K., N.K., K.B.W., O.A.), University of Cincinnati, OH
| | - Natalie Kreitzer
- Department of Emergency Medicine (C.K., N.K., K.B.W., O.A.), University of Cincinnati, OH
| | - Katrina Peariso
- Division of Neurology (K.P.), Cincinnati Children’s Hospital Medical Center, OH
| | | | - Peyman Shirani
- Department of Neurology (J.H., E.S., E.A., R. J. S., J.P.B., S. L. D., M.L.F., A. W. G., P.S., P.K.), University of Cincinnati, OH
| | - Kyle B. Walsh
- Department of Emergency Medicine (C.K., N.K., K.B.W., O.A.), University of Cincinnati, OH
| | - Holly Lampton
- Department of Communications, Hamilton County, Cincinnati, OH (H.L.)
| | - Opeolu Adeoye
- Department of Emergency Medicine (C.K., N.K., K.B.W., O.A.), University of Cincinnati, OH
| | - Pooja Khatri
- Department of Neurology (J.H., E.S., E.A., R. J. S., J.P.B., S. L. D., M.L.F., A. W. G., P.S., P.K.), University of Cincinnati, OH
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Johnson MD, Prestigiacomo CJ, Ferioli S, Flaherty ML. Persistent Hypoglossal Artery and Concurrent Carotid Thrombus. Ann Neurol 2020; 88:233-234. [DOI: 10.1002/ana.25795] [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] [Received: 04/08/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Mark D. Johnson
- Department of Neurosurgery University of Cincinnati Cincinnati OH USA
| | | | - Simona Ferioli
- Department of Neurology University of Cincinnati Cincinnati OH USA
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Moudgal RA, Zare-Shahabadi A, Mowla A, Grossman AW, Prestigiacomo CJ, Shirani P. Massive Orofacial Hemorrhage Treated with the Micro Vascular Plug System. World Neurosurg 2020; 143:79-82. [PMID: 32589981 DOI: 10.1016/j.wneu.2020.06.120] [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: 02/12/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND This case series describes the use of the Medtronic Micro Vascular Plug (MVP) system in the treatment of acute massive orofacial hemorrhages in patients with cancer and trauma, resulting in successful hemostasis in these emergent cases. CASE DESCRIPTION The first case describes a patient who presented with life-threatening oropharyngeal hemorrhage after a motor vehicle accident. In the second case, a patient with oropharyngeal cancer presented with life-threatening bleeding from an ulcerated tumor. Patients were successfully treated with a combination of MVP and coils. Immediate postprocedural imaging confirmed that homeostasis was achieved. CONCLUSIONS These cases demonstrate that the MVP as an embolic device is a valuable transarterial embolic treatment option in cases of acute orofacial bleeding where rapid, effective hemostasis is required.
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Affiliation(s)
- Rohitha A Moudgal
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ameneh Zare-Shahabadi
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ashkan Mowla
- Department of Neurological Surgery, University of Southern California, Los Angeles, California, USA
| | - Aaron W Grossman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Charles J Prestigiacomo
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Peyman Shirani
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
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Smith MS, Bonomo J, Knight WA, Prestigiacomo CJ, Richards CT, Ramser E, Adeoye O, Bertsch S, Shirani P, Vagal A, Fichtenbaum CJ, Housholder A, Khatri P, Kleindorfer DO, Broderick JP, Grossman AW. Endovascular Therapy for Patients With Acute Ischemic Stroke During the COVID-19 Pandemic: A Proposed Algorithm. Stroke 2020; 51:1902-1909. [PMID: 32352910 PMCID: PMC7199768 DOI: 10.1161/strokeaha.120.029863] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/03/2020] [Accepted: 04/20/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Matthew S. Smith
- From the Department of Neurology (M.S.S., J.B., W.A.K., P.S., P.K., D.O.K., J.P.B.)
| | - Jordan Bonomo
- From the Department of Neurology (M.S.S., J.B., W.A.K., P.S., P.K., D.O.K., J.P.B.)
- Department of Neurosurgery (J.B., W.A.K., C.J.P., O.A., P.S., A.W.G.)
- Department of Emergency Medicine (J.B., W.A.K., C.T.R., O.A.)
| | - William A. Knight
- From the Department of Neurology (M.S.S., J.B., W.A.K., P.S., P.K., D.O.K., J.P.B.)
- Department of Neurosurgery (J.B., W.A.K., C.J.P., O.A., P.S., A.W.G.)
- Department of Emergency Medicine (J.B., W.A.K., C.T.R., O.A.)
| | | | | | - Evan Ramser
- Division of Pulmonary Critical Care, Department of Internal Medicine (E.R.)
| | - Opeolu Adeoye
- Department of Neurosurgery (J.B., W.A.K., C.J.P., O.A., P.S., A.W.G.)
- Department of Emergency Medicine (J.B., W.A.K., C.T.R., O.A.)
| | | | - Peyman Shirani
- From the Department of Neurology (M.S.S., J.B., W.A.K., P.S., P.K., D.O.K., J.P.B.)
- Department of Neurosurgery (J.B., W.A.K., C.J.P., O.A., P.S., A.W.G.)
| | | | | | - Anne Housholder
- Cincinnati Veterans Affairs Medical Center, Department of Dermatology/Healthcare Ethics Consultant - Certified (HEC-C) (A.H.), University of Cincinnati, OH
| | - Pooja Khatri
- From the Department of Neurology (M.S.S., J.B., W.A.K., P.S., P.K., D.O.K., J.P.B.)
| | - Dawn O. Kleindorfer
- From the Department of Neurology (M.S.S., J.B., W.A.K., P.S., P.K., D.O.K., J.P.B.)
| | - Joseph P. Broderick
- From the Department of Neurology (M.S.S., J.B., W.A.K., P.S., P.K., D.O.K., J.P.B.)
| | - Aaron W. Grossman
- Department of Neurosurgery (J.B., W.A.K., C.J.P., O.A., P.S., A.W.G.)
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Prestigiacomo CJ. The history of the Journal of Neurosurgery: how the "White Journal" helped in the growth of neurological surgery. J Neurosurg 2019; 131:1347-1355. [PMID: 31675692 DOI: 10.3171/2019.7.jns181528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 11/06/2022]
Abstract
As the Journal of Neurosurgery (JNS) enters its 76th year of publication, its role as a principal repository of the neurosurgical body of knowledge continues to rise. Following in the steps of earlier journals in other disciplines, the JNS was founded to help provide experts in the field of neurological surgery a forum to present and interpret the important data that have shaped the way the field is practiced around the world. Though not exclusive in its mission, the "White Journal" innovated the management as well as the delivery of information and has served as an example for neurosurgical journals born thereafter.As with all events, the foundational elements of the JNS are centered on the needs of the times. An understanding of the precipitating events and the individuals instrumental in its genesis and subsequent maturation brings to light the JNS's main focus: to be the principal journal for the field.
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Giridharan N, Patel SK, Ojugbeli A, Nouri A, Shirani P, Grossman AW, Cheng J, Zuccarello M, Prestigiacomo CJ. Understanding the complex pathophysiology of idiopathic intracranial hypertension and the evolving role of venous sinus stenting: a comprehensive review of the literature. Neurosurg Focus 2019; 45:E10. [PMID: 29961379 DOI: 10.3171/2018.4.focus18100] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 11/06/2022]
Abstract
Idiopathic intracranial hypertension (IIH) is a disease defined by elevated intracranial pressure without established etiology. Although there is now consensus on the definition of the disorder, its complex pathophysiology remains elusive. The most common clinical symptoms of IIH include headache and visual complaints. Many current theories regarding the etiology of IIH focus on increased secretion or decreased absorption of cerebrospinal fluid (CSF) and on cerebral venous outflow obstruction due to venous sinus stenosis. In addition, it has been postulated that obesity plays a role, given its prevalence in this population of patients. Several treatments, including optic nerve sheath fenestration, CSF diversion with ventriculoperitoneal or lumboperitoneal shunts, and more recently venous sinus stenting, have been described for medically refractory IIH. Despite the availability of these treatments, no guidelines or standard management algorithms exist for the treatment of this disorder. In this paper, the authors provide a review of the literature on IIH, its clinical presentation, pathophysiology, and evidence supporting treatment strategies, with a specific focus on the role of venous sinus stenting.
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Affiliation(s)
| | | | | | | | - Peyman Shirani
- Departments of1Neurosurgery and.,2Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Aaron W Grossman
- Departments of1Neurosurgery and.,2Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Nael K, Sakai Y, Khatri P, Prestigiacomo CJ, Puig J, Vagal A. Imaging-based Selection for Endovascular Treatment in Stroke. Radiographics 2019; 39:1696-1713. [DOI: 10.1148/rg.2019190030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Riccardello GJ, Shastri DN, Changa AR, Thomas KG, Roman M, Prestigiacomo CJ, Gandhi CD. Influence of Relative Residence Time on Side-Wall Aneurysm Inception. Neurosurgery 2019; 83:574-581. [PMID: 28945849 DOI: 10.1093/neuros/nyx433] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 07/21/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Relative residence time (RRT) is a marker of disturbed blood flow, marked by low magnitude and high oscillatory wall shear stress (WSS). The relation between solute residence time in proximity to the vascular endothelium and the atherosclerotic process is well appreciated in the literature. OBJECTIVE To assess the influence of RRT on side-wall aneurysm inception to better understand the role of atherosclerosis in aneurysm formation. METHODS Fourteen side-wall internal carotid artery aneurysms from the Aneurisk repository which met criteria for parent vessel reconstruction were reconstructed with Vascular Modeling Toolkit. Computational fluid dynamics analysis was carried out in Fluent. RRT was calculated in MATLAB (The MathWorks Inc, Natick, Massachusetts). We analyzed the results for correlations, defined as presence or absence of local elevations in RRT in specific regions of vasculature. RESULTS RRT was concluded to be negatively correlated with aneurysm inception in this study of side-wall internal carotid artery aneurysms, with 12/14 cases yielding the absence of local RRT elevations within or in close proximity of the removed ostium. Subsequent analysis of WSS showed that 11 of 14 aneurysms were formed in an atheroprotective environment, with only 1 of 14 formed in an atherogenic environment. Two models were found to be of indeterminate environment. CONCLUSION Atherogenesis and atherosclerosis have long been thought to be a major inciting factor responsible for the formation of aneurysms in the cerebral vasculature. We propose that inception of side-wall aneurysms occurs in hemodynamic environments that promote an atheroprotective endothelial phenotype and that the atheroprotective phenotype is therefore aneurysmogenic.
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Affiliation(s)
- Gerald J Riccardello
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Darshan N Shastri
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Abhinav R Changa
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Kiran G Thomas
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Max Roman
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey
| | | | - Chirag D Gandhi
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,Department of Radiology, Rutgers New Jersey Medical School, Newark, New Jersey
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Prestigiacomo CJ, Gounis MJ, Gonzalez LF, Frösen J. Introduction. Formation, growth, and rupture: the biology and physics of cerebral aneurysms. Neurosurg Focus 2019; 47:E1. [PMID: 31261113 DOI: 10.3171/2019.4.focus19333] [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: 11/06/2022]
Affiliation(s)
| | - Matthew J Gounis
- 2Division of Neuroimaging and Intervention, and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | | | - Juhana Frösen
- 4Department of Neurosurgery, Kuopio University, Kuopio, Finland
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Prestigiacomo CJ. Editorial. Looking at aneurysms by the numbers: morphometrics and the potentials of aneurysm analysis. Neurosurg Focus 2019; 47:E6. [PMID: 31261129 DOI: 10.3171/2019.4.focus19332] [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: 11/06/2022]
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Abstract
Wall shear stress, the frictional force of blood flow tangential to an artery lumen, has been demonstrated in multiple studies to influence aneurysm formation and risk of rupture. In this article, the authors review the ways in which shear stress may influence aneurysm growth and rupture through changes in the vessel wall endothelial cells, smooth-muscle cells, and surrounding adventitia, and they discuss shear stress–induced pathways through which these changes occur.
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Affiliation(s)
| | - Matthew Smith
- 2Neurology, University of Cincinnati Medical Center, Cincinnati, Ohio
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Prestigiacomo CJ. Commentary: The Zurich Checklist for Safety in the Intraoperative Magnetic Resonance Imaging Suite: Technical Note. Oper Neurosurg (Hagerstown) 2019; 16:E163-E164. [PMID: 30189022 DOI: 10.1093/ons/opy227] [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] [Received: 06/26/2018] [Accepted: 07/19/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Charles J Prestigiacomo
- Department of Neurological Surgery, Division of Cerebrovascular and Endovascular Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Prestigiacomo CJ. Commentary: Multicenter Study of Pipeline Flex for Intracranial Aneurysms. Neurosurgery 2019; 84:E412-E413. [PMID: 30481311 DOI: 10.1093/neuros/nyy528] [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] [Received: 09/01/2018] [Accepted: 10/07/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Charles J Prestigiacomo
- Department of Neurological surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Kayan Y, Meyers PM, Prestigiacomo CJ, Kan P, Fraser JF. Current endovascular strategies for posterior circulation large vessel occlusion stroke: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee. J Neurointerv Surg 2019; 11:1055-1062. [DOI: 10.1136/neurintsurg-2019-014873] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/17/2019] [Accepted: 04/22/2019] [Indexed: 01/30/2023]
Abstract
BackgroundThe aim of this publication is to provide a detailed update on the diagnosis, treatment, and endovascular techniques for posterior circulation emergent large vessel occlusion (pc-ELVO).MethodsWe performed a review of the literature to specifically evaluate this disease and its treatments.ResultsData were analyzed, and recommendations were reported based on the strength of the published evidence and expert consensus.ConclusionWhile many questions about pc-ELVO remain to be studied, there is evidence to support particular practices in its evaluation and treatment.
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