1
|
Hohenstatt S, Saatci I, Jesser J, Çekirge HS, Koçer N, Islak C, Lücking H, DuPlessis J, Rautio R, Bendszus M, Vollherbst DF, Möhlenbruch MA. Prasugrel Single Antiplatelet Therapy versus Aspirin and Clopidogrel Dual Antiplatelet Therapy for Flow Diverter Treatment for Cerebral Aneurysms: A Retrospective Multicenter Study. AJNR Am J Neuroradiol 2024; 45:592-598. [PMID: 38453414 DOI: 10.3174/ajnr.a8163] [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: 10/27/2023] [Accepted: 01/07/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND PURPOSE The optimal antiplatelet regimen after flow diverter treatment of cerebral aneurysms is still a matter of debate. A single antiplatelet therapy might be advantageous in determined clinical scenarios. This study evaluated the efficacy and safety of prasugrel single antiplatelet therapy versus aspirin and clopidogrel dual antiplatelet therapy. MATERIALS AND METHODS We performed a post hoc analysis of 4 retrospective multicenter studies including ruptured and unruptured aneurysms treated with flow diversion using either prasugrel single antiplatelet therapy or dual antiplatelet therapy. Primary end points were the occurrence of any kind of procedure- or device-related thromboembolic complications and complete aneurysm occlusion at the latest radiologic follow-up (mean, 18 months). Dichotomized comparisons of outcomes were performed between single antiplatelet therapy and dual antiplatelet therapy. Additionally, the influence of various patient- and aneurysm-related variables on the occurrence of thromboembolic complications was investigated using multivariable backward logistic regression. RESULTS A total of 222 patients with 251 aneurysms were included, 90 (40.5%) in the single antiplatelet therapy and 132 (59.5%) in the dual antiplatelet therapy group. The primary outcome-procedure- or device-related thromboembolic complications-occurred in 6 patients (6.6%) of the single antiplatelet therapy and in 12 patients (9.0%) of the dual antiplatelet therapy group (P = .62; OR, 0.712; 95% CI, 0.260-1.930). The primary treatment efficacy end point was reached in 82 patients (80.4%) of the single antiplatelet therapy and in 115 patients (78.2%) of the dual antiplatelet therapy group (P = .752; OR, 1.141; 95% CI, 0.599-2.101). Logistic regression showed that non-surface-modified flow diverters (P = .014) and fusiform aneurysm morphology (P = .004) significantly increased the probability of thromboembolic complications. CONCLUSIONS Prasugrel single antiplatelet therapy after flow diverter treatment may be as safe and effective as dual antiplatelet therapy and could, therefore, be a valid alternative in selected patients. Further prospective comparative studies are required to validate our findings.
Collapse
Affiliation(s)
- Sophia Hohenstatt
- From the Department of Neuroradiology (S.H., J.J., M.B., D.F.V., M.A.M.), Heidelberg University Hospital, Heidelberg, Germany
| | - Işıl Saatci
- Interventional Neuroradiology Section (I.S., H.S.C.), Koru and Bayindir Private Hospitals, Ankara, Turkey
| | - Jessica Jesser
- From the Department of Neuroradiology (S.H., J.J., M.B., D.F.V., M.A.M.), Heidelberg University Hospital, Heidelberg, Germany
| | - H Saruhan Çekirge
- Interventional Neuroradiology Section (I.S., H.S.C.), Koru and Bayindir Private Hospitals, Ankara, Turkey
| | - Naci Koçer
- Department of Neuroradiology (N.K., CI.), Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Civan Islak
- Department of Neuroradiology (N.K., CI.), Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Hannes Lücking
- Department of Neuroradiology (H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - Johannes DuPlessis
- Department of Clinical Neurosciences (J.D.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Riitta Rautio
- Department of Interventional Radiology (R.R.), Turku University Hospital, Turku, Finland
| | - Martin Bendszus
- From the Department of Neuroradiology (S.H., J.J., M.B., D.F.V., M.A.M.), Heidelberg University Hospital, Heidelberg, Germany
| | - Dominik F Vollherbst
- From the Department of Neuroradiology (S.H., J.J., M.B., D.F.V., M.A.M.), Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A Möhlenbruch
- From the Department of Neuroradiology (S.H., J.J., M.B., D.F.V., M.A.M.), Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
2
|
R BS, Korkmazer B, Süleyman K, Hikmat E, Kocer N, Islak C, Tureci E, Ruijters D, Kizilkilic O. Dynamic (live) 3D roadmap as navigational tool in multiplug brain arteriovenous malformation embolization: technical note. Neuroradiology 2024; 66:129-133. [PMID: 37993730 DOI: 10.1007/s00234-023-03250-6] [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: 07/19/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Treatment of brain arteriovenous malformation (bAVM) includes microsurgical excision, stereotactic radiosurgery, endovascular embolization, or combination. With bAVM embolization, complete angiographic obliteration ranges from 12.5 to 51%, and higher total occlusion rate is seen in SM grades I to III, ranging from 96 to 100%. METHODS In this paper, we illustrate the use of 3D rotational angiography and dynamic (live) 3D roadmap functions in endovascular treatment of bAVM. A single dynamic 3D roadmap or two dynamic 3D roadmaps obtained help tremendously in navigation of microcatheters and wires along the parent artery and bAVM feeders. RESULTS This method eliminates the need for repeated 2D angiograms and roadmaps for new working projections every time the C-arm position is changed for cannulation of different feeders, thereby reducing radiation dose. No instances of misalignment error, vascular perforation, or thromboembolic phenomena were observed in the 21 embolization cases performed within the previous 2 years while utilizing this feature. CONCLUSION The dynamic 3D roadmap is an extremely useful tool for multiple-feeder cannulation, by reducing the use of multiple 2D angiograms, providing intraprocedural live and adjustable 3D roadmap for better mental orientation to angioarchitecture of the bAVM, which further aids in the overall complete angiographic obliteration rate of bAVM in a single session especially in multiplug embolization technique.
Collapse
Affiliation(s)
- Bibi Sadaqat R
- Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Bora Korkmazer
- Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Kanullah Süleyman
- Department of Radiology, Cam and Sakura State Hospital Istanbul, İstanbul, Turkey
| | - Emil Hikmat
- Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Naci Kocer
- Department of Radiology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ercan Tureci
- Department of Anaesthesia, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Daniel Ruijters
- Interventional X-Ray (iXR), Philips Healthcare, Best, The Netherlands
| | - Osman Kizilkilic
- Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul, Turkey.
| |
Collapse
|
3
|
Korkmazer B, Karaman AK, Ustundag A, Arslan S, Kızılkılıç O, Koçer N, Islak C. Magnetic resonance perfusion imaging findings following flow diversion in patients with complex middle cerebral artery bifurcation aneurysms: a single-center analysis regarding the jailed cortical branches. J Neurointerv Surg 2023; 16:8-14. [PMID: 36963822 DOI: 10.1136/jnis-2023-020124] [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: 01/24/2023] [Accepted: 03/07/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Flow diverter (FD) devices provide a safe and effective treatment option especially for wide-necked intracranial aneurysms. One of the main concerns in patients treated with FD devices is patency of arterial branches jailed by the stent. However, there are no long-term data from magnetic resonance perfusion (MRP) studies regarding jailed branches. In this study we aimed to reveal the MRP findings in patients with jailed middle cerebral artery (MCA) cortical branches during long-term follow-up after flow diversion. METHODS Patients who underwent FD stent treatment for MCA aneurysms with a resulting jailed cortical branch were included. Follow-up clinical, angiographic, and MRP examination findings were recorded. Different MRP parameters were measured in the MCA territory regarding the jailed branches. RESULTS Eighteen patients treated endovascularly with flow diversion for a total of 20 MCA aneurysms were included. At angiographic follow-up (median 35 months, range 7-95 months) complete occlusion was observed in 13 (65%) aneurysms and partial occlusion was observed in 6 (30%). The mean transit time (MTT) prolongation, MTT ratio, time-to peak (TTP) prolongation, and TTP ratio were 1.34, 1.20, 1.18, and 1.06 s, respectively, when compared with the contralateral side in the MCA territory. MTT, TTP, and cerebral blood volume values of the patients showed statistically significant differences compared with the contralateral side (P<0.05). CONCLUSIONS Flow diversion treatment of complex bifurcation aneurysms can be effective and safe. MRP examination may reveal perfusion changes in the territory vascularized via a jailed branch, and these changes are rarely accompanied by clinical findings.
Collapse
Affiliation(s)
- Bora Korkmazer
- Division of Neuroradiology, Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Kursat Karaman
- Department of Radiology, Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Ustundag
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Serdar Arslan
- Division of Neuroradiology, Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Osman Kızılkılıç
- Division of Neuroradiology, Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Naci Koçer
- Division of Neuroradiology, Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Civan Islak
- Division of Neuroradiology, Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
4
|
Lopes DK, Hanel RA, Levy EI, Cekirge HS, Lylyk P, Saatci I, Liu J, Kocer N, Mounayer C, Kizilkilic O, Moret J, Spelle L, Chapot R, Islak C, Goel G, Yang P, Berdikhojayev M, Orlov K, Siddiqui AH. Counterpoint: The important educational value of live surgical broadcasts. J Neurointerv Surg 2023; 15:1171-1174. [PMID: 37652691 DOI: 10.1136/jnis-2023-020694] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/02/2023]
Affiliation(s)
| | - Ricardo A Hanel
- Department of Neurosurgery, Lyerly Neurosurgery, Jacksonville, Florida, USA
| | - Elad I Levy
- Departments of Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - H Saruhan Cekirge
- Department of Radiology, Koru Health Group, Ankara, Turkey
- Private Office, Saruhan Cekirge, Ankara, Turkey
| | - Pedro Lylyk
- Department of Interventional Neuroradiology, ENERI-Clínica Sagrada Familia, CABA, Argentina
| | | | - Jianmin Liu
- Second Mil Med University, Shanghai, Shanghai, China
| | - Naci Kocer
- Department of Radiology, Cerrahpasa Medical School, Istanbul, Turkey
| | - Charbel Mounayer
- Department of Interventional Neuroadiology, Dupuytren Hospital, Limoges, France
| | | | - Jacques Moret
- NEURI the Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France
- Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Laurent Spelle
- NEURI the Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France
- Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - René Chapot
- Department of Interventional Neuroradiology, Alfried Krupp Hospital Ruttenscheid, Essen, Germany
| | - Civan Islak
- Department of Radiology, Cerrahpasa Medical School, Istanbul, Turkey
| | - Gaurav Goel
- Department of Neurointervention, Medanta The Medicity Medanta Institute of Neurosciences, Gurugram, Haryana, India
| | - Pengfei Yang
- Department of Neurosurgery, Naval Medical University Changhai Hospital, Shanghai, Shanghai, China
| | | | - Kirill Orlov
- Endovascular Neurosurgery Research Center, Federal Center of Brain Research and Neurotechnologies of the Federal Medical Biological Agency of Russia, Moscow, Russia
| | - Adnan H Siddiqui
- Departments of Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| |
Collapse
|
5
|
Korkmazer B, Arslan S, Onal EM, Ozogul M, Urganci N, Isler C, Comunoglu N, Kizilkilic O, Kocer N, Islak C. Imaging findings of intraventricular pilocytic astrocytoma. Br J Radiol 2023; 96:20220598. [PMID: 37660368 PMCID: PMC10646651 DOI: 10.1259/bjr.20220598] [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: 06/13/2022] [Revised: 06/12/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE The aim of this study is to present the clinical and imaging findings of 16 patients with intraventricular pilocytic astrocytomas (PAs). METHODS 16 patients with histopathological diagnosis of intraventricular PA between February 2016 and January 2022 were evaluated retrospectively. Imaging and clinical findings of the patients, as well as apparent diffusion coefficient (ADC) measurements were analyzed. RESULTS Of 16 patients, 8 (%50) were male and 8 (%50) were female. The mean age of the patients was 20.8 years (2-44 years range). The most common symptoms in the patients were headache and ataxia. The mean long-axis size of lesions was found to be 48.19 ± 21.59 (range, 15-92 mm). 9 out of 16 lesions (56.2%) were located in the fourth ventricle. The majority of the lesions were iso-hypointense in T1W and hyperintense in T2W images. The mean ADC value of PAs was 1.57 × 10-3 ± 0.2 mm2/s, while the mean thalamic ADC and white matter ADC values were found to be 0.78 × 10-3 ± 0.04 and 0.76 × 10-3 ± 0.06 mm2/s, respectively. There was a statistically significant difference between the ADC values obtained from the solid components of the lesions and the thalami/white matter (p < 0.001). CONCLUSION PAs often originate from midline structures, however, they can also be located intraventricularly. Although intraventricular PAs are frequently seen in pediatric population, it should be kept in mind that they can also be seen in adults, albeit rarely. ADVANCES IN KNOWLEDGE PA should be considered in the differential diagnosis of intraventricular neoplasms in case of high ADC values.
Collapse
Affiliation(s)
- Bora Korkmazer
- Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Serdar Arslan
- Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Emine Meltem Onal
- Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Murat Ozogul
- Department of Radiology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Nil Urganci
- Department of Pathology, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Cihan Isler
- Department of Neurosurgery, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Nil Comunoglu
- Department of Pathology, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Naci Kocer
- Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| |
Collapse
|
6
|
Benalia VHC, Cortez GM, Mounayer C, Saatci I, Cekirge HS, Kocer N, Islak C, Dabus G, Brinjikji W, Baltacioglu F, Pereira VM, Nishi H, Siddiqui AH, Monteiro A, Lopes DK, Aghaebrahim A, Sauvageau E, Hanel RA. Safety and Efficacy of Flow Diverters for Treatment of Unruptured Anterior Communicating Artery Aneurysms: Retrospective Multicenter Study. J Neurointerv Surg 2023; 15:1181-1186. [PMID: 37845019 DOI: 10.1136/jnis-2023-020673] [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: 06/12/2023] [Accepted: 08/16/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND The anterior communicating artery (AComm) region is the most common site of intracranial aneurysms, with increased rupture risk compared with other locations. Overall, flow diverters present as a safe and efficacious treatment for intracranial aneurysms, but there is paucity of data for their use in the treatment of unruptured AComm aneurysms. We present the largest multicentric analysis evaluating the outcomes of flow diverters in AComm aneurysm treatment. METHODS Databases from 10 centers were retrospectively reviewed for unruptured AComm aneurysms treated with flow diverters. Demographics, clinical presentation, radiographic characteristics, procedural complications, and outcomes were assessed. RESULTS A total of 144 patients harboring 147 AComm aneurysms were treated between January 2012 and December 2021. Seventy-four were women (51.4%) and median age was 60 (IQR 50-67) years. All were unruptured AComm aneurysms. Half of the cohort had similar anterior cerebral artery sizes (51.4%). The most common morphology was saccular (94.6%), with a branch involvement in 32.7% of cases. Median vessel diameter was 2.4 mm, and the Pipeline Flex was the most prevalent device (32.7%). Median follow-up time was 17 months, with complete occlusion in 86.4% at the last follow-up. Functional independence (modified Rankin Scale score 0-2) was reported in 95.1%. Intraprocedural complications occurred in 5.6%, and postoperative complications were noted in 9.7% of cases. Combined major complication and mortality rate was 2.1%. CONCLUSIONS Our study suggests that flow diverters are a useful treatment for AComm aneurysms. Mid-term results indicated favorable aneurysm occlusion with a good safety profile. Additional prospective studies with longer follow-up periods and independent adjudication are warranted to better assess these results.
Collapse
Affiliation(s)
- Victor H C Benalia
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Gustavo M Cortez
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Charbel Mounayer
- Interventional Neuroradiology Department, University Hospital Centre of Limoges, Limoges, France
| | - Isil Saatci
- Interventional Neuroradiology Department, Koru Health Group, Ankara, Turkey
| | - H Saruhan Cekirge
- Interventional Neuroradiology Department, Koru Health Group, Ankara, Turkey
| | - Naci Kocer
- Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Fatih, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Fatih, Istanbul, Turkey
| | - Guilherme Dabus
- Interventional Neuroradiology and Neuroendovascular Surgery, Miami Neuroscience Institute and Miami Cardiac and Vascular Institute-Baptist Hospital, Miami, Florida, USA
| | - Waleed Brinjikji
- Department of Neurosurgery and Neuroradiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Feyyaz Baltacioglu
- Department of Radiology, Division of Interventional Radiology/Neuroradiology, VKV Amerikan Hastanesi, Istanbul, Turkey
| | - Vitor M Pereira
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Hidehisa Nishi
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Adnan H Siddiqui
- Departments of Neurosurgery and Radiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Andre Monteiro
- Departments of Neurosurgery and Radiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Demetrius K Lopes
- Neurosurgery, Brain and Spine Institute-Advocate Aurora Health, Chicago, Illinois, USA
| | - Amin Aghaebrahim
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Ricardo A Hanel
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| |
Collapse
|
7
|
Suleyman K, Korkmazer B, Kocer N, Islak C, Kızılkılıc O. Evaluation of short- and long-term results of Y-stent-assisted coiling with Leo stents in endovascular treatment of wide-necked intracranial bifurcation aneurysms. Neuroradiology 2023; 65:785-791. [PMID: 36651939 DOI: 10.1007/s00234-023-03116-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/23/2022] [Accepted: 01/06/2023] [Indexed: 01/19/2023]
Abstract
PURPOSE This study aimed to evaluate the feasibility, safety, and efficacy of Y-stent-assisted coiling (Y-SAC) using LEO Baby® stents in treating of bifurcation aneurysms. METHODS Patients who underwent Y-SAC using a braided stent (LEO Baby®, Montmorency, France) for wide-necked intracranial aneurysms between 2009 and 2019 and whose radiological and clinical follow-up data for at least 6 months could be obtained were evaluated. Data were obtained from patient records and analyzed retrospectively. RESULTS We evaluated 111 patients with a mean age of 56.0 ± 10.8 years (range, 25-88 years). Most of the aneurysms were detected incidentally. Three patients had ruptured aneurysms. LEO Baby deployment and coiling were successful in all patients. Immediate aneurysm occlusion rates were determined as modified Raymond-Roy classification (mRRC) I 95.5% (n = 106), mRRC II 3.6% (n = 4), mRRC IIIa 0.9% (n = 1). In the sixth month, aneurysm occlusion rates were found to be complete and nearly complete in all patients (mRRC I 94.6%, n = 105 and mRRC II 4.5%; n = 5, respectively). Follow-up data of 91 patients for > 2 years were obtained. Of these, 88 had MRRCI obstruction and 3 had MRRC II obstruction. The overall complication rate was 4.8%, and one patient died during the post-procedural follow-up. CONCLUSION The long-term follow-up results of Y-stenting with LEO Baby revealed that it provides stable closure of the aneurysm sac while preserving the main arterial structures. Therefore, it is a safe, durable, and effective method for treating wide-necked and complex bifurcation aneurysms.
Collapse
Affiliation(s)
- Kanullah Suleyman
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Bora Korkmazer
- Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Naci Kocer
- Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Civan Islak
- Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Osman Kızılkılıc
- Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
- Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical School, Kocamustafapasa, Istanbul, 34300, Turkey.
| |
Collapse
|
8
|
Benalia V, Cortez G, Mounayer C, Saatci I, Cekirge S, Koçer N, Islak C, Dabus G, Brinjikji W, Baltacıoğlu F, Pereira VM, Nishi H, Siddiqui A, Lopes DK, Aghaebrahim A, Sauvageau E, Hanel RA. 315 Use of Flow Diverter in the Treatment of Anterior Communicating Artery Aneurysms: A Multicenter Experience (FEAR ME study). Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_315] [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
|
9
|
Korkmazer B, Karaman AK, Kızılkılıç EK, Unkun R, Arslan S, Uygunoğlu U, Kızılkılıç O, Koçer N, Islak C. Efficacy of Dural Sinus Quantitative Measurements in Idiopathic Intracranial Hypertension : A Practical Diagnostic Feature. Clin Neuroradiol 2022; 33:545-554. [PMID: 36577853 DOI: 10.1007/s00062-022-01244-0] [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: 08/17/2022] [Accepted: 11/17/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to investigate the potential contribution of quantitative measurements of dural venous sinuses to the diagnosis of idiopathic intracranial hypertension (IIH) and the relationship between IIH and dural venous sinus dimensions on 3D post-gadolinium T1-weighted magnetic resonance (MR) images. MATERIAL AND METHODS A total of 129 individuals (57 IIH patients and 72 controls) who complained of headache and underwent both magnetic resonance venography (MRV) and precontrast/postcontrast 3D T1-weighted MR imaging between 2018 and 2021 were included in this retrospective study. Dural venous sinus and jugular vein diameters were measured in all cases using post-gadolinium 3D T1 TFE images. The presence of transverse sinus (TS) hypoplasia and occipital sinus variation, the number and size of arachnoid granulations in the TS, and the presence of brain parenchymal herniation were also evaluated. Cut-off values that maximized accurate diagnosis of IIH were established on the receiver operating characteristic curve. The sensitivity and specificity of the diagnosis of IIH based on quantitative measurements of the dural sinus were calculated. RESULTS The ratios of the maximum to minimum TS diameters and the minimum TS diameters to minimum sigmoid sinus (SS) diameters were significantly higher in IIH patients than in the control group (p < 0.001). The diagnostic sensitivity and specificity values of TSmax/TSmin and TSmin sum/SSmin sum parameters for the detection of IIH were 84.2%, 84.7% and 83.3%, 84.2%, respectively. CONCLUSION Practical measurements from multiplanar T1 sequences can be useful for both quantitative assessment and overcoming misinterpretation due to anatomical variation.
Collapse
Affiliation(s)
- Bora Korkmazer
- Division of Neuroradiology, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey.
- , Cerrahpasa Tıp Fakültesi Yerleşkesi Kocamustafapasa Cd. No: 53 Cerrahpaşa, 34098, Fatih/Istanbul, Turkey.
| | - Ahmet Kursat Karaman
- Department of Radiology, Sureyyapasa Chest Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
| | - Esra Kochan Kızılkılıç
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Rümeysa Unkun
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdar Arslan
- Division of Neuroradiology, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Uğur Uygunoğlu
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Osman Kızılkılıç
- Division of Neuroradiology, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Naci Koçer
- Division of Neuroradiology, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Civan Islak
- Division of Neuroradiology, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
10
|
Karaman AK, Korkmazer B, Arslan S, Kızılkılıç O, Koçer N, Islak C. Spontaneous internal carotid artery dissection in a child diagnosed by high resolution vessel wall MRI. Childs Nerv Syst 2022; 39:1101-1105. [PMID: 36369383 DOI: 10.1007/s00381-022-05745-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
Craniocervical dissection is one of the most common causes of stroke in children. Although the most common cause of dissection is trauma, spontaneous dissections in which no cause can be revealed may also occur. The diagnosis of this type of dissection in children can be challenging with the preferred non-invasive imaging methods (MRA, CTA). Intracranial vessel wall imaging is a promising novel method for identifying specific signs of dissection. We report an 11-year-old girl with spontaneous ICA dissection, whose diagnosis was confirmed by an MRI of the intracranial vessel wall. Vessel wall imaging has contributed substantially to the diagnosis and follow-up of this case.
Collapse
Affiliation(s)
- Ahmet Kursat Karaman
- Department of Radiology, Sureyyapasa Chest Diseases and Thoracic Surgery Training Hospital, Başıbüyük Mah, Hastane Yolu Cad, Istanbul, 34844, Turkey.
| | - Bora Korkmazer
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdar Arslan
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Osman Kızılkılıç
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Naci Koçer
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
11
|
Adeeb N, Dibas M, Griessenauer CJ, Cuellar HH, Salem MM, Xiang S, Enriquez-Marulanda A, Hong T, Zhang H, Taussky P, Grandhi R, Waqas M, Aldine AS, Tutino VM, Aslan A, Siddiqui AH, Levy EI, Ogilvy CS, Thomas AJ, Ulfert C, Möhlenbruch MA, Renieri L, Bengzon Diestro JD, Lanzino G, Brinjikji W, Spears J, Vranic JE, Regenhardt RW, Rabinov JD, Harker P, Müller-Thies-Broussalis E, Killer-Oberpfalzer M, Islak C, Kocer N, Sonnberger M, Engelhorn T, Kapadia A, Yang VXD, Salehani A, Harrigan MR, Krings T, Matouk CC, Mirshahi S, Chen KS, Aziz-Sultan MA, Ghorbani M, Schirmer CM, Goren O, Dalal SS, Finkenzeller T, Holtmannspötter M, Buhk JH, Foreman PM, Cress MC, Hirschl RA, Reith W, Simgen A, Janssen H, Marotta TR, Stapleton CJ, Patel AB, Dmytriw AA. Learning Curve for Flow Diversion of Posterior Circulation Aneurysms: A Long-Term International Multicenter Cohort Study. AJNR Am J Neuroradiol 2022; 43:1615-1620. [PMID: 36229166 PMCID: PMC9731249 DOI: 10.3174/ajnr.a7679] [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: 02/06/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Flow diversion has gradually become a standard treatment for intracranial aneurysms of the anterior circulation. Recently, the off-label use of the flow diverters to treat posterior circulation aneurysms has also increased despite initial concerns of rupture and the suboptimal results. This study aimed to explore the change in complication rates and treatment outcomes across time for posterior circulation aneurysms treated using flow diversion and to further evaluate the mechanisms and variables that could potentially explain the change and outcomes. MATERIALS AND METHODS A retrospective review using a standardized data set at multiple international academic institutions was performed to identify patients with ruptured and unruptured posterior circulation aneurysms treated with flow diversion during a decade spanning January 2011 to January 2020. This period was then categorized into 4 intervals. RESULTS A total of 378 procedures were performed during the study period. Across time, there was an increasing tendency to treat more vertebral artery and fewer large vertebrobasilar aneurysms (P = .05). Moreover, interventionalists have been increasingly using fewer overlapping flow diverters per aneurysm (P = .07). There was a trend toward a decrease in the rate of thromboembolic complications from 15.8% in 2011-13 to 8.9% in 2018-19 (P = .34). CONCLUSIONS This multicenter experience revealed a trend toward treating fewer basilar aneurysms, smaller aneurysms, and increased usage of a single flow diverter, leading to a decrease in the rate of thromboembolic and hemorrhagic complications.
Collapse
Affiliation(s)
- N Adeeb
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - M Dibas
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - C J Griessenauer
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
- Department of Neurology/Institut of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - H H Cuellar
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - M M Salem
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - S Xiang
- Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - A Enriquez-Marulanda
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - T Hong
- Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - H Zhang
- Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - P Taussky
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery (P.T., R.G.), University of Utah, Salt Lake City, Utah
| | - R Grandhi
- Department of Neurosurgery (P.T., R.G.), University of Utah, Salt Lake City, Utah
| | - M Waqas
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - A S Aldine
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - V M Tutino
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - A Aslan
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - A H Siddiqui
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - E I Levy
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - C S Ogilvy
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - A J Thomas
- Department of Neurological Surgery (A.J.T.), Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey
| | - C Ulfert
- Department of Neuroradiology (C.U., M.A.M.), Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - M A Möhlenbruch
- Department of Neuroradiology (C.U., M.A.M.), Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - L Renieri
- Department of Interventional Neuroradiology (L.R.), University of Florence, Florence, Italy
| | - J D Bengzon Diestro
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., J.S., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - G Lanzino
- Department of Neurological Surgery (G.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - W Brinjikji
- Department of Neurological Surgery (G.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - J Spears
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., J.S., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - J E Vranic
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - R W Regenhardt
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - J D Rabinov
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - P Harker
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - E Müller-Thies-Broussalis
- Department of Neurology/Institut of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - M Killer-Oberpfalzer
- Department of Neurology/Institut of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - C Islak
- Department of Neuroradiology (C.I., N.K.), Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - N Kocer
- Department of Neuroradiology (C.I., N.K.), Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - M Sonnberger
- Department of Neuroradiology (M.S.), Kepler Universitätsklinikum Linz, Linz, Austria
| | - T Engelhorn
- Department of Neuroradiology (T.E.), University Hospital Erlangen, Erlangen, Germany
| | - A Kapadia
- Departments of Medical Imaging and Neurosurgery (A.K.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - V X D Yang
- Neurointerventional Program (V.X.D.Y., A.A.D.), Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, Ontario, Canada
| | - A Salehani
- Department of Neurosurgery (A. Salehani, M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama
| | - M R Harrigan
- Department of Neurosurgery (A. Salehani, M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama
| | - T Krings
- Division of Interventional Neuroradiology (T.K.), Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - C C Matouk
- Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, Connecticut
| | - S Mirshahi
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - K S Chen
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - M A Aziz-Sultan
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - M Ghorbani
- Division of Vascular and Endovascular Neurosurgery (M.G.), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - C M Schirmer
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
| | - O Goren
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
| | - S S Dalal
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
| | - T Finkenzeller
- Institute of Radiology and Neuroradiology (T.F., M.H.), Klinikum Nuernberg Sued, Paracelsus Medical University Nuernberg, Nuernberg, Germany
| | - M Holtmannspötter
- Institute of Radiology and Neuroradiology (T.F., M.H.), Klinikum Nuernberg Sued, Paracelsus Medical University Nuernberg, Nuernberg, Germany
- Department of Neuroradiology (M.H.), Klinikum Weiden, Weiden, Germany
| | - J-H Buhk
- Department of Neuroradiology (J.-H.B.), University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - P M Foreman
- Neuroscience and Rehabilitation Institute (P.M.F., M.C.C., R.A.H.), Orlando Health, Orlando, Florida
| | - M C Cress
- Neuroscience and Rehabilitation Institute (P.M.F., M.C.C., R.A.H.), Orlando Health, Orlando, Florida
| | - R A Hirschl
- Neuroscience and Rehabilitation Institute (P.M.F., M.C.C., R.A.H.), Orlando Health, Orlando, Florida
| | - W Reith
- Clinic for Diagnostic and Interventional Neuroradiology (W.R., A. Simgen), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - A Simgen
- Clinic for Diagnostic and Interventional Neuroradiology (W.R., A. Simgen), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - H Janssen
- Institute for Neuroradiology (H.J.), Klinikum Ingolstadt, Ingolstadt, Germany
| | - T R Marotta
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., J.S., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - C J Stapleton
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - A B Patel
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - A A Dmytriw
- Neurointerventional Program (V.X.D.Y., A.A.D.), Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, Ontario, Canada
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
12
|
Jesser J, Alberalar ND, Kizilkilic O, Saatci I, Baltacioglu F, Özlük E, Killer-Oberpfalzer M, Vollherbst DF, Islak C, Cekirge SH, Bendszus M, Möhlenbruch M, Koçer N. Safety and Efficacy of the FRED Jr Flow Re-Direction Endoluminal Device for Intracranial Aneurysms: Retrospective Multicenter Experience With Emphasis on Midterm Results. Front Neurol 2021; 12:722183. [PMID: 34659086 PMCID: PMC8518710 DOI: 10.3389/fneur.2021.722183] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/02/2021] [Indexed: 02/03/2023] Open
Abstract
Background and Purpose: Flow diversion is increasingly used as an endovascular treatment for intracranial aneurysms. In this retrospective multicenter study, we analyzed the safety and efficacy of the treatment of intracranial, unruptured, or previously treated but recanalized aneurysms using Flow Re-Direction Endoluminal Device (FRED) Jr with emphasis on midterm results. Materials and Methods: Clinical and radiological records of 150 patients harboring 159 aneurysms treated with FRED Jr at six centers between October 2014 and February 2020 were reviewed and consecutively included. Clinical outcome was measured by using the modified Rankin Scale (mRS). Anatomical results were assessed according to the O'Kelly-Marotta (OKM) scale and the Cekirge-Saatci Classification (CSC) scale. Results: The overall complication rate was 24/159 (16%). Thrombotic-ischemic events occurred in 18/159 treatments (11%). These resulted in long-term neurological sequelae in two patients (1%) with worsening from pre-treatment mRS 0–2 and mRS 4 after treatment. Complete or near-complete occlusion of the treated aneurysm according to the OKM scale was reached in 54% (85/158) at 6-month, in 68% (90/133) at 1-year, and in 83% (77/93) at 2-year follow-up, respectively. The rates of narrowing or occlusion of a vessel branch originating from the treated aneurysm according to the CSC scale were 11% (12/108) at 6-month, 20% (17/87) at 1-year, and 23% (13/57) at 2-year follow-up, respectively, with all cases being asymptomatic. Conclusions: In this retrospective multicenter study, FRED Jr was safe and effective in the midterm occlusion of cerebral aneurysms. Most importantly, it was associated with a high rate of good clinical outcome.
Collapse
Affiliation(s)
- Jessica Jesser
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Nilüfer D Alberalar
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Leipzig, Germany
| | - Osman Kizilkilic
- Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Isil Saatci
- Interventional Neuroradiology Section, Koru and Bayindir, Private Hospitals, Ankara, Turkey
| | - Feyyaz Baltacioglu
- Department of Radiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Enes Özlük
- Department of Radiology, Acibadem Atakent Hospital, Istanbul, Turkey
| | | | - Dominik F Vollherbst
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Civan Islak
- Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Saruhan H Cekirge
- Interventional Neuroradiology Section, Koru and Bayindir, Private Hospitals, Ankara, Turkey
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Naci Koçer
- Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul, Turkey
| |
Collapse
|
13
|
Islak C, Bagcilar O, Nacar Dogan S, Korkmazer B, Arslan S, Kizilkilic O, Kocer N. Endovascular management of anterior falcotentorial dural arteriovenous fistulas: importance of functionality of deep venous system and existence of accompanying choroidal arteriovenous malformation. J Neurointerv Surg 2021; 14:599-604. [PMID: 34321350 DOI: 10.1136/neurintsurg-2021-017730] [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: 05/05/2021] [Accepted: 07/04/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Anterior falcotentorial junction dural arteriovenous fistulas (AFDAVFs) are the most deeply located and most complex type of tentorial fistula due to their location and vascular anatomy. We aimed to make new angiographic definitions of AFDAVF nidus and functionality of the deep venous system of the brain and thereby provide a safer approach for endovascular treatment. METHODS We retrospectively examined 18 patients with AFDAVF who received endovascular treatment at our neuroradiology department between June 2002 and May 2019. Pre- and post-treatment clinical assessments were performed using the modified Rankin Scale. AFDAVF niduses were defined as mixed-type or pure-dural-type on the basis of whether choroidal arteriovenous malformation was coexisting or not, respectively. The deep venous system was denoted as functional or nonfunctional. RESULTS We included 13 men and 5 women (mean (range) age, 47.2 (31-62) years). We evaluated 15 patients with pure-dural-type AFDAVFs and three with mixed-type AFDAVFs. Complete occlusion of the fistula was achieved in 15/18 patients. Three patients had transient neurologic symptoms. In two patients these were due to mild thalamic ischemia and in the third patient was due to tectal venous ischemia, all in mixed-type AFDAVF. One patient also developed Parinaud syndrome due to compression of the tectal plate by a thrombosed large vein of Galen. No patients died or developed permanent morbidity. CONCLUSION Evaluating AFDAVFs as described here using our new subtyping model will help improve analysis of the malformation and development of a safer endovascular strategy, and hence may prevent periprocedural complications and improve treatment safety.
Collapse
Affiliation(s)
- Civan Islak
- Department of Radiology Division of Neuroradiology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Omer Bagcilar
- Department of Radiology, Silivri State Hospital, Istanbul, Turkey
| | - Sebahat Nacar Dogan
- Department of Radiology, Gaziosmanpaşa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Bora Korkmazer
- Department of Radiology Division of Neuroradiology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Serdar Arslan
- Department of Radiology Division of Neuroradiology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology Division of Neuroradiology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Naci Kocer
- Department of Radiology Division of Neuroradiology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
14
|
Kandemirli SG, Baltacioglu F, Jesser J, Kizilkilic O, Islak C, Möhlenbruch M, Kocer N. Flow Redirection Endoluminal Device (FRED) with or without Adjunctive Coiling in Treatment of Very Large and Giant Cerebral Aneurysms. Clin Neuroradiol 2021; 32:471-480. [PMID: 34309708 DOI: 10.1007/s00062-021-01061-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: 03/20/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Flow diverter stents are gaining wider use in the treatment of complex intracranial aneurysms; however, there are limited data on occlusion and complication rates of flow diverters in very large and giant aneurysms. This study assessed the safety and efficacy of flow redirection endoluminal device (FRED) and FRED Jr. stents in aneurysms ≥ 20 mm. METHODS We retrospectively analyzed all aneurysms ≥ 20 mm treated with FRED/FRED Jr. between January 2010 and June 2020 from three centers. Endpoints for clinical safety were absence of major stroke, aneurysmal rupture, or death and complete or near-complete occlusion for efficacy. RESULTS A total of 45 patients with very large (28 cases) and giant aneurysms (17 cases) were treated with FRED (41 cases), and FRED Jr. (4 cases) stents. The majority of the aneurysms (40/45, 88.9%) were in the anterior circulation. Adjunctive aneurysm coiling was performed in 21 aneurysms (46.7%). Technical complications were encountered in 4 procedures (8.9%). Ischemic and hemorrhagic complication rates were 6.7% and 8.9%, respectively. There was no case with major stroke. The mortality rate was 8.9%, and all cases were due to hemorrhagic complications from aneurysmal rupture. Median angiographic follow-up was 21.5 months (range 3-60 months). Complete occlusion was achieved in 32 aneurysms (71.1%), and near-complete occlusion in 5 cases (11.1%). CONCLUSION The use of FRED/FRED Jr. for the treatment of aneurysms ≥ 20 mm achieved a long-term aneurysm occlusion rate and a safety profile comparable to the large series reported with other flow diverter stents.
Collapse
Affiliation(s)
| | - Feyyaz Baltacioglu
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey.,Department of Radiology, VKV American Hospital, Istanbul, Turkey
| | - Jessica Jesser
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Osman Kizilkilic
- Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Markus Möhlenbruch
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Naci Kocer
- Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul, Turkey.
| |
Collapse
|
15
|
Cimflova P, Özlük E, Korkmazer B, Ahmadov R, Akpek E, Kizilkilic O, Islak C, Kocer N. Long-term safety and efficacy of distal aneurysm treatment with flow diversion in the M2 segment of the middle cerebral artery and beyond. J Neurointerv Surg 2020; 13:631-636. [PMID: 33082291 DOI: 10.1136/neurintsurg-2020-016790] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Indications for flow diversion stent (FDS) treatment are expanding. However, there is still a lack of evidence for the long-term outcome in distally located aneurysms in the M2 segment of the middle cerebral artery (MCA) and beyond. METHODS Consecutive subjects (from June 2013 to August 2020) with MCA aneurysms in the M2 segment or beyond treated with FDS were reviewed retrospectively. The primary endpoints for clinical safety were the absence of mortality, stroke event, re-rupture of the aneurysm, and worsening of clinical symptoms. The primary endpoint for treatment efficacy was complete/near-complete occlusion at follow-up after 12 months. RESULTS 23 patients were identified: 7 aneurysms were located in the M2 segment of the MCA, 4 in the M2-M3 bifurcation, 2 in M3, 3 in M3-4 branching, and 2 in M4; 5 aneurysms were located in M2 with extension into the M1-M2 bifurcation. 13 aneurysms were of fusiform morphology, 8 sacculofusiform, and 2 saccular. 16 aneurysms were of highly suspected dissecting etiology. The median diameter of the parent vessel was 2.1 mm proximally and 2 mm distally. The median time of the follow-up was 30 months (range 16 months to 6 years). Complete/near complete occlusion was observed in 14/20 patients (70%) and one stable remodeling (5%) was seen at 12 months. 22 patients (95.6%) had an excellent clinical outcome (mRS 0-1) at 6 months. Technical challenges associated with the deployment of FDS occurred in 8.7% of cases. Severe complications, intraparenchymal hemorrhage and re-rupture of the aneurysm occurred in 2 patients (8.7%). CONCLUSION Flow diversion of distally located aneurysms is technically feasible with low morbidity and mortality.
Collapse
Affiliation(s)
- Petra Cimflova
- Department of Medical Imaging, St. Anne's University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Enes Özlük
- Department of Radiology, Acibadem Atakent Hospital, Istanbul, Turkey
| | - Bora Korkmazer
- Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ramiz Ahmadov
- Department of Neurosurgery, Acibadem Atakent Hospital, Istanbul, Turkey
| | - Elif Akpek
- Department of Anaestesiology and Reanimation, Acibadem Universitesi Medical Faculty, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Civan Islak
- Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Naci Kocer
- Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
16
|
Gul B, Samanci C, Uluduz DU, Alis D, Midi I, Kocer N, Islak C, Kizilkilic O. Does measurement of the jugular foramen diameter on MRI help to differentiate transverse sinus thrombosis from unilateral transverse sinus hypoplasia? Radiol Med 2020; 126:430-436. [PMID: 32857273 DOI: 10.1007/s11547-020-01265-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE The transverse sinus (TS) is a frequent location of cerebral venous thrombosis. However, unilateral TS hypoplasia is a frequent variation and radiological imaging pitfall in the diagnosis because it may mimic unilateral TS thrombosis. The purpose of this study is to find a cutoff value for bilateral jugular foramen (JF) diameter ratios on magnetic resonance imaging (MRI) for differentiating TS thrombosis from TS hypoplasia. MATERIALS AND METHODS We retrospectively reviewed magnetic resonance venography results for 174 patients with reduced unilateral TS caliber resulting from either unilateral thrombosis (80 patients) or unilateral hypoplasia (94 patients). We calculated the ratio by proportioning the diameter of the JF ipsilateral to the TS with caliber reduction to the diameter of the contralateral JF. The Mann-Whitney U test was used to compare the ratios between thrombosis and hypoplasia groups, and the cutoff value was calculated by receiver-operating characteristic curve analysis. RESULTS The ratio of bilateral JF diameters was lower in patients with hypoplasia than those with thrombosis (P < .01). The cutoff value to determine the diagnosis of TS hypoplasia with maximum accuracy was 0.638, with a sensitivity of 91.3% and specificity of 64.9%. CONCLUSION In equivocal cases, calculating the cutoff value by proportioning the diameter of JF ipsilateral to the TS with caliber reduction to the contralateral JF seems to be an efficient, quick, and straightforward method and valuable aid to differentiate TS thrombosis from TS hypoplasia.
Collapse
Affiliation(s)
- Burcu Gul
- Department of Radiology, Cerrahpaşa Faculty of Medicine, İstanbul University, Istanbul, Turkey.
| | - Cesur Samanci
- Department of Radiology, Sultan Abdulhamidhan Training and Research Hospital, Istanbul, Turkey
| | - Derya Ugurlu Uluduz
- Department of Neurology, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Deniz Alis
- Department of Radiology, Cerrahpaşa Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Ipek Midi
- Department of Neurology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Naci Kocer
- Department of Radiology, Cerrahpaşa Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Cerrahpaşa Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Cerrahpaşa Faculty of Medicine, İstanbul University, Istanbul, Turkey
| |
Collapse
|
17
|
Dabus G, Kan P, Diaz C, Pabon B, Andres-Mejia J, Linfante I, Grossberg JA, Howard BM, Islak C, Kocer N, Kizilkilic O, Puri AS, Kuhn AL, Moholkar V, Ortega-Gutierrez S, Samaniego EA, McDermott MW. Endovascular treatment of anterior cranial fossa dural arteriovenous fistula: a multicenter series. Neuroradiology 2020; 63:259-266. [PMID: 32840681 DOI: 10.1007/s00234-020-02536-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 06/10/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE We report a multicenter experience using endovascular embolization as the first line approach for treatment of anterior cranial fossa (ACF) dural arteriovenous fistula (DAVF). METHODS All patients with DAVFs located in the anterior cranial fossa who were treated with endovascular technique as a first line approach were included. Demographics, clinical presentation, angioarchitecture, strategy, complications, immediate angiographic, and follow-up results were included in the analysis. RESULTS Twenty-three patients met the inclusion criteria (18 male and 5 female). Age ranged from 14 to 79 years (mean 53 years). Twelve patients presented with hemorrhage. Twenty-eight endovascular procedures were performed. The overall immediate angiographic cure rate after endovascular treatment was 82.6% (19/23 patients). The angiographic cure rate of the transvenous strategy was significantly superior to the transarterial strategy (p ≤ 0.001). There was 1 complication in 28 total procedures (3.6%). Angiographic follow-up was available in 21 out of the 23 patients with a mean of 25 months (range 2 to 108 months). In these 21 patients, the DAVF was completely cured in 20 (95%). At last follow-up, all patients had a modified Rankin scale (mRS) 0 to 2. CONCLUSION Our experience suggests that endovascular treatment for ACF DAVFs has an acceptable safety profile with high rates of complete occlusion, particularly with transvenous approach. Whenever possible, transvenous approach should be preferred over transarterial approach as first line strategy.
Collapse
Affiliation(s)
- Guilherme Dabus
- Division of Interventional Neuroradiology/NeuroEndovascular Surgery, Miami Neuroscience Institute - Baptist Hospital, Miami, FL, USA.
- Miami Cardiac & Vascular Institute, 8900 N. Kendall Drive, Miami, FL, 33176, USA.
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Carlos Diaz
- Interventional Neuroradiology at Incare, Universidad de Antioquia, Medellin, Colombia
| | - Boris Pabon
- Interventional Neuroradiology at Angioteam, Medellin, Colombia
| | | | - Italo Linfante
- Division of Interventional Neuroradiology/NeuroEndovascular Surgery, Miami Neuroscience Institute - Baptist Hospital, Miami, FL, USA
| | | | - Brian M Howard
- Department of Neurosurgery, Emory University, Atlanta, GA, USA
| | - Civan Islak
- Department of Neuroradiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Naci Kocer
- Department of Neuroradiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Neuroradiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts, Worcester, MA, USA
| | - Anna L Kuhn
- Department of Radiology, University of Massachusetts, Worcester, MA, USA
| | - Viraj Moholkar
- Department of Radiology, University of Massachusetts, Worcester, MA, USA
| | | | - Edgar A Samaniego
- Department of Neurology and Radiology, University of Iowa, Iowa City, IA, USA
| | - Michael W McDermott
- Division of Interventional Neuroradiology/NeuroEndovascular Surgery, Miami Neuroscience Institute - Baptist Hospital, Miami, FL, USA
| |
Collapse
|
18
|
Griessenauer CJ, Enriquez-Marulanda A, Xiang S, Hong T, Zhang H, Taussky P, Grandhi R, Waqas M, Tutino VM, Siddiqui AH, Levy EI, Ogilvy CS, Thomas AJ, Ulfert C, Möhlenbruch MA, Renieri L, Limbucci N, Parra-Fariñas C, Burkhardt JK, Kan P, Rinaldo L, Lanzino G, Brinjikji W, Spears J, Müller-Thies-Broussalis E, Killer-Oberpfalzer M, Islak C, Kocer N, Sonnberger M, Engelhorn T, Ghuman M, Yang VX, Salehani A, Harrigan MR, Radovanovic I, Pereira VM, Krings T, Matouk CC, Chen K, Aziz-Sultan MA, Ghorbani M, Schirmer CM, Goren O, Dalal SS, Koch MJ, Stapleton CJ, Patel AB, Finkenzeller T, Holtmannspötter M, Buhk JH, Foreman PM, Cress M, Hirschl R, Reith W, Simgen A, Janssen H, Marotta TR, Dmytriw AA. Comparison of PED and FRED flow diverters for posterior circulation aneurysms: a propensity score matched cohort study. J Neurointerv Surg 2020; 13:153-158. [PMID: 32611622 DOI: 10.1136/neurintsurg-2020-016055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/26/2020] [Revised: 05/14/2020] [Accepted: 05/25/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Flow diversion is a common endovascular treatment for cerebral aneurysms, but studies comparing different types of flow diverters are scarce. OBJECTIVE To perform a propensity score matched cohort study comparing the Pipeline Embolization Device (PED) and Flow Redirection Intraluminal Device (FRED) for posterior circulation aneurysms. METHODS Consecutive aneurysms of the posterior circulation treated at 25 neurovascular centers with either PED or FRED were collected. Propensity score matching was used to control for age, duration of follow-up imaging, adjunctive coiling, and aneurysm location, size, and morphology; previously ruptured aneurysms were excluded. The two devices were compared for the following outcomes: procedural complications, aneurysm occlusion, and functional outcome. RESULTS A total of 375 aneurysms of the posterior circulation were treated in 369 patients. The PED was used in 285 (77.2%) and FRED in 84 (22.8%) procedures. Aneurysms treated with the PED were more commonly fusiform and larger than those treated with FRED. To account for these important differences, propensity score matching was performed resulting in 33 PED and FRED unruptured aneurysm pairs. No differences were found in occlusion status and neurologic thromboembolic or hemorrhagic complications between the two devices. The proportion of patients with favorable functional outcome was higher with FRED (100% vs 87.9%, p=0.04). CONCLUSION Comparative analysis of PED and FRED for the treatment of unruptured posterior circulation aneurysms did not identify significant differences in aneurysm occlusion or neurologic complications. Variations in functional outcomes warrant additional investigations.
Collapse
Affiliation(s)
- Christoph J Griessenauer
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA .,Research Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Sissi Xiang
- Department of Neurosurgery, Xuanwu Hospital, Beijing, China
| | - Tao Hong
- Department of Neurosurgery, Xuanwu Hospital, Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Beijing, China
| | - Philipp Taussky
- Department of Neurosurgery, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Muhammad Waqas
- Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Vincent M Tutino
- Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Christopher S Ogilvy
- Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ajith J Thomas
- Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Christian Ulfert
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Leonardo Renieri
- Interventional Neuroradiology, University Hospital Careggi, Firenze, Toscana, Italy
| | - Nicola Limbucci
- Interventional Neuroradiology, University Hospital Careggi, Firenze, Toscana, Italy
| | | | - Jan-Karl Burkhardt
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Lorenzo Rinaldo
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Waleed Brinjikji
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Julian Spears
- Therapeutic Neuroradiology & Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Erasmia Müller-Thies-Broussalis
- Research Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria.,Department of Neurology, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
| | - Monika Killer-Oberpfalzer
- Research Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria.,Department of Neurology, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
| | - Civan Islak
- Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Naci Kocer
- Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Michael Sonnberger
- Department of Neuroradiology, Johannes Kepler Universitat Linz, Linz, Austria
| | - Tobias Engelhorn
- Department of Neuroradiology, Friedrich Alexander University Erlangen Nuremberg Faculty of Medicine, Erlangen, Bayern, Germany
| | - Mandeep Ghuman
- Neuroradiology & Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Victor Xd Yang
- Neuroradiology & Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Mark R Harrigan
- Department of Neurosurgery, UAB Hospital, Birmingham, Alabama, USA
| | - Ivan Radovanovic
- Interventional Neuroradiology & Neurosurgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Vitor M Pereira
- Interventional Neuroradiology & Neurosurgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Timo Krings
- Interventional Neuroradiology & Neurosurgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Charles C Matouk
- Department of Neurosurgery, Yale University, New Haven, Connecticut, USA
| | - Karen Chen
- Neurointerventional Radiology and Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Mohammad Ghorbani
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Clemens M Schirmer
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA.,Research Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Oded Goren
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA
| | - Shamsher S Dalal
- Department of Radiology, Geisinger Health System, Danville, Pennsylvania, USA
| | - Matthew J Koch
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Jan Hendrik Buhk
- Department of Diagnostic and Interventional Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Wolfgang Reith
- Department of Neuroradiology, Universitatsklinikum des Saarlandes und Medizinische Fakultat der Universitat des Saarlandes, Homburg, Germany
| | - Andreas Simgen
- Department of Neuroradiology, Universitatsklinikum des Saarlandes und Medizinische Fakultat der Universitat des Saarlandes, Homburg, Germany
| | - Hendrik Janssen
- Department of Neuroradiology, Nuremberg Hospital, Nurnberg, Bayern, Germany
| | - Thomas R Marotta
- Therapeutic Neuroradiology & Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Adam A Dmytriw
- Therapeutic Neuroradiology & Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada.,Neuroradiology & Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Interventional Neuroradiology & Neurosurgery, Toronto Western Hospital, Toronto, ON, Canada
| |
Collapse
|
19
|
Dogan SN, Salt V, Korkmazer B, Arslan S, Islak C, Kocer N, Kizilkilic O. Intrathecal use of gadobutrol for gadolinium-enhanced MR cisternography in the evaluation of patients with otorhinorrhea. Neuroradiology 2020; 62:1381-1387. [PMID: 32535661 DOI: 10.1007/s00234-020-02463-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/20/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Intrathecal gadolinium-enhanced MR cisternography (IGE-MRC) has a high sensitivity to detect accurate localization of cerebrospinal fluid (CSF) leakage in otorhinorrhea patients. Our purpose in this study was to describe our experience in analyzing clinically suspected CSF leakage by IGE-MRC by using gadobutrol with emphasis on its safety and diagnostic performance. METHODS We retrospectively reviewed our imaging and clinical database for the evaluation of patients admitted to our clinic with complaints of otorhinorrhea between 2017 and 2019. Two radiologists evaluated the imaging studies independently. Consensus data was used in the analysis. Medical record review and phone call were used for the follow-up. RESULTS Of the 85 patients included in the retrospective analysis, 82 (96.5%) had rhinorrhea and 3 (3.5%) had otorrhea. Overall, 29 patients (34.1% of all patients) underwent operation for repair of the CSF leakage site. Beta-transferrin test was available and positive in 33 patients (38.8%). Five (5.9%) patients complained headaches after the procedure and complaints were resolved with increased water intake. Postprocedurally, 3 patients (3.5%) had vertigo and 1 patient (1.2%) complained nausea but spontaneous regression were observed in a few hours. None of the patients experienced a significant complication or adverse reaction during follow-up period. Sixty-seven patients (78.8%) had medical record and telephone follow-up. Mean follow-up duration with call was 14.2 months. CONCLUSION IGE-MRC is a minimally invasive and highly sensitive imaging technique. The current results during our follow-up demonstrate the relative safety and feasibility of IGE-MRC by using gadobutrol to evaluate CSF leakage.
Collapse
Affiliation(s)
- Sebahat Nacar Dogan
- Gaziosmanpaşa Training and Research Hospital, Department of Radiology, University of Health Sciences Turkey, 34098, Istanbul, Turkey
| | - Vefa Salt
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Bora Korkmazer
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Serdar Arslan
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Naci Kocer
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa Medical Faculty, Istanbul, Turkey.
| |
Collapse
|
20
|
Griessenauer CJ, Möhlenbruch MA, Hendrix P, Ulfert C, Islak C, Sonnberger M, Engelhorn T, Müller-Thies-Broussalis E, Finkenzeller T, Holtmannspötter M, Buhk JH, Reith W, Simgen A, Janssen H, Kocer N, Killer-Oberpfalzer M. The FRED for Cerebral Aneurysms of the Posterior Circulation: A Subgroup Analysis of the EuFRED Registry. AJNR Am J Neuroradiol 2020; 41:658-662. [PMID: 32115421 DOI: 10.3174/ajnr.a6447] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/14/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flow diversion for the posterior circulation remains a promising treatment option for selected posterior circulation aneurysms. The Flow-Redirection Intraluminal Device (FRED) system has not been previously assessed in a large cohort of patients with posterior circulation aneurysms. The purpose of the present study was to assess safety and efficacy of FRED in this location. MATERIALS AND METHODS Consecutive patients with posterior circulation aneurysms treated at 8 centers participating in the European FRED study (EuFRED) between April 2012 and January 2019 were retrospectively reviewed. Complication and radiographic and functional outcomes were evaluated. RESULTS Eighty-four patients (median age, 54 years) with 84 posterior circulation aneurysms were treated with the FRED. A total of 25 aneurysms (29.8%) had previously ruptured, even though most aneurysms were diagnosed incidentally (45.2%). The intradural vertebral artery was the most common location (50%), and saccular, the most common morphology (40.5%). The median size was 7 mm. There were 8 (9.5%) symptomatic thromboembolic and no hemorrhagic complications. Thromboembolic complications occurred mostly (90.9%) in nonsaccular aneurysms. On last follow-up at a median of 24 months, 78.2% of aneurysms were completely occluded. Functional outcome at a median of 27 months was favorable in 94% of patients. All mortalities occurred in patients with acute subarachnoid hemorrhage and its sequelae. CONCLUSIONS The largest cohort of posterior circulation aneurysms treated with the FRED to date demonstrated favorable safety and efficacy profiles of the device for this indication. Treatment in the setting of acute subarachnoid hemorrhage was strongly related to mortality, regardless of whether procedural complications occurred.
Collapse
Affiliation(s)
- C J Griessenauer
- From the Research Institute of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), Paracelsus Medical University, Salzburg, Austria .,Department of Neurosurgery (C.J.G.), Geisinger, Danville, Pennsylvania
| | - M A Möhlenbruch
- Department of Neuroradiology (M.A.M., C.U.), Heidelberg University Hospital, Heidelberg, Germany
| | - P Hendrix
- Department of Neurosurgery (P.H.), Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - C Ulfert
- Department of Neuroradiology (M.A.M., C.U.), Heidelberg University Hospital, Heidelberg, Germany
| | - C Islak
- Department of Neuroradiology (C.I., N.K.), Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - M Sonnberger
- Department of Neuroradiology (M.S.), Kepler Universitätsklinikum, Linz, Austria
| | - T Engelhorn
- Department of Neuroradiology (T.E.), University Hospital Erlangen, Erlangen, Germany
| | - E Müller-Thies-Broussalis
- From the Research Institute of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), Paracelsus Medical University, Salzburg, Austria
| | - T Finkenzeller
- Institute of Radiology and Neuroradiology (T.F., M.H.), Klinikum Nuernberg Sued, Paracelsus Medical University, Nuernberg, Germany.,Department of Neuroradiology (T.F.), Klinikum Weiden, Weiden, Bavaria, Germany
| | - M Holtmannspötter
- Institute of Radiology and Neuroradiology (T.F., M.H.), Klinikum Nuernberg Sued, Paracelsus Medical University, Nuernberg, Germany
| | - J-H Buhk
- Department of Neuroradiology (J.-H.B.), University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - W Reith
- Clinic for Diagnostic and Interventional Neuroradiology (W.R., A.S.), Universitätsklinikum des Saarlandes, Homburg/Saar, Homburg, Saarland, Germany
| | - A Simgen
- Clinic for Diagnostic and Interventional Neuroradiology (W.R., A.S.), Universitätsklinikum des Saarlandes, Homburg/Saar, Homburg, Saarland, Germany
| | - H Janssen
- Institute for Neuroradiology (H.J.), Klinikum Ingolstadt, Ingolstadt, Germany
| | - N Kocer
- Department of Neuroradiology (C.I., N.K.), Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - M Killer-Oberpfalzer
- From the Research Institute of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
21
|
Alis D, Bagcilar O, Senli YD, Isler C, Yergin M, Kocer N, Islak C, Kizilkilic O. The diagnostic value of quantitative texture analysis of conventional MRI sequences using artificial neural networks in grading gliomas. Clin Radiol 2020; 75:351-357. [PMID: 31973941 DOI: 10.1016/j.crad.2019.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 08/19/2019] [Accepted: 12/11/2019] [Indexed: 01/12/2023]
Abstract
AIM To explore the value of quantitative texture analysis of conventional magnetic resonance imaging (MRI) sequences using artificial neural networks (ANN) for the differentiation of high-grade gliomas (HGG) and low-grade gliomas (LGG). MATERIALS AND METHODS A total of 181 patients, 97 with HGG (53.5%) and 84 with LGG (46.5%) with brain MRI having T2-weighted (W) fluid attenuation inversion recovery (FLAIR), and contrast-enhanced T1W images were enrolled in the present study. Histogram parameters and high-order texture features were extracted using manually placed regions of interest (ROIs) on T2W-FLAIR and contrast-enhanced T1W images covering the whole volume of the tumours. The reproducibility of the features was assessed by interobserver reliability analyses. The cohort was divided into training (n=121) and test partitions (n=60). The training set was used for attribute selection and model development, and the test set was used to evaluate the diagnostic performance of the pre-trained ANNs in discriminating HGG and LGG. RESULTS In the test cohort, the ANN models using texture data of T2W-FLAIR and contrast-enhanced T1W images achieved an area under the receiver operating characteristic curve (AUC) of 0.87 and 0.86, respectively. The combined ANN model with selected texture features achieved the highest diagnostic accuracy equating 88.3% with an AUC of 0.92. CONCLUSIONS Quantitative texture analysis of T2W-FLAIR and contrast-enhanced T1W enhanced by ANN can accurately discriminate HGG from LGG and might be of clinical value in tailoring the management strategies in patients with gliomas.
Collapse
Affiliation(s)
- D Alis
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Radiology, Halkali, Istanbul, Turkey.
| | - O Bagcilar
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Radiology, KMPasa, Istanbul, Turkey
| | - Y D Senli
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Radiology, KMPasa, Istanbul, Turkey
| | - C Isler
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Neurosurgery, KMPasa, Istanbul, Turkey
| | - M Yergin
- Bahcesehir University, Department of Software Engineering and Applied Sciences, Istanbul, Turkey
| | - N Kocer
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Radiology, KMPasa, Istanbul, Turkey
| | - C Islak
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Radiology, KMPasa, Istanbul, Turkey
| | - O Kizilkilic
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Radiology, KMPasa, Istanbul, Turkey
| |
Collapse
|
22
|
Kocer N, Kandemirli SG, Ruijters D, Mantatzis M, Kizilkilic O, Islak C. A technical note on intra-arterial cone-beam computed tomography for the evaluation of flow-diverter stents: Image quality differences between diluted and non-diluted contrast medium. Interv Neuroradiol 2019; 26:164-169. [DOI: 10.1177/1591019919890929] [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] Open
Abstract
Background Design of flow-diverter stents for flexibility, tractability, and low profile limits their radiopacity on conventional digital subtraction angiography. Cone-beam computed tomography (CBCT) offers higher spatial resolution for the evaluation of flow-diverter stents. However, CBCT requires optimal dilution and timing of contrast medium for simultaneous visualization of the stent, arterial lumen, and vessel wall. There are only limited data on the effects of different contrast dilutions on CBCT image quality in neurointerventional applications. Materials and methods In our institution, intra-arterial CBCTs were acquired during stent deployment and at follow-ups with 10% diluted contrast. We had recently started acquiring intra-arterial CBCTs with non-diluted contrast. Retrospective analysis of our flow-diverter data identified eight cases with different aneurysm locations who had intra-arterial CBCT with 10% diluted contrast immediately after flow-diverter stent deployment and with non-diluted contrast technique during follow-ups. For each case, the image quality between diluted and non-diluted contrast techniques was compared qualitatively by assessing stent visualization and quantitatively by plotting gray-scale intensity values along the vessel lumen. Results In two sets of CBCT images per each case, there was no substantial difference between diluted and non-diluted CBTC techniques for the evaluation of stent architecture and lumen opacification. Gray-scale intensity values perpendicular to the lumen revealed similar intensity values along the neighboring parenchyma, vessel wall, and lumen for the two different contrast techniques. Conclusion Intra-arterial CBCT angiography can be performed without contrast dilution and still achieve adequate image quality in certain cerebral aneurysms treated with flow diverter. The non-diluted contrast technique avoids the time loss during preparation of diluted contrast and installation of diluted contrast to the injector in angiography suites with a single power injector.
Collapse
Affiliation(s)
- Naci Kocer
- Division of Neuroradiology, Department of Radiology, Cerrahapasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sedat G Kandemirli
- Division of Neuroradiology, Department of Radiology, Cerrahapasa Medical Faculty, Istanbul University, Istanbul, Turkey
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Daniel Ruijters
- Philips Healthcare, Image Guided Therapy Systems Innovation, Best, the Netherlands
| | - Michalis Mantatzis
- Division of Neuroradiology, Department of Radiology, Democritus University of Thrace, Komotini, Greece
| | - Osman Kizilkilic
- Division of Neuroradiology, Department of Radiology, Cerrahapasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Civan Islak
- Division of Neuroradiology, Department of Radiology, Cerrahapasa Medical Faculty, Istanbul University, Istanbul, Turkey
| |
Collapse
|
23
|
Alis D, Bagcilar O, Senli YD, Yergin M, Isler C, Kocer N, Islak C, Kizilkilic O. Machine learning-based quantitative texture analysis of conventional MRI combined with ADC maps for assessment of IDH1 mutation in high-grade gliomas. Jpn J Radiol 2019; 38:135-143. [PMID: 31741126 DOI: 10.1007/s11604-019-00902-7] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/11/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE To assess the performance of texture analysis of conventional magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) maps in predicting IDH1 status in high-grade gliomas (HGG). MATERIALS AND METHODS A total of 142 patients with HGG were included in the study. IDH1 mutation was present in 48 of 142 HGG (33.8%). Patients were randomly divided into the training cohort (n = 96) and the validation cohort (n = 46). Texture features were extracted via regions of interest on axial T2WI FLAIR, post-contrast T1WI, and ADC maps covering the whole volume of the tumors. The training cohort was used to train the random forest classifier, and the diagnostic performance of the pre-trained model was tested on the validation cohort. RESULTS The random forest model of conventional MRI sequences and ADC images achieved diagnostic accuracy of 82.2% and 80.4% in predicting IDH1 status in the validation cohorts, respectively. The combined model of T2WI FLAIR, post-contrast T1WI, and ADC images exhibited the highest diagnostic accuracy equating 86.94% in the validation cohort. CONCLUSION Texture analysis of conventional MRI sequences enhanced by ML analysis can accurately predict the IDH1 status of HGG. Adding textural analysis of ADC maps to conventional MRI results in incremental diagnostic performance.
Collapse
Affiliation(s)
- Deniz Alis
- Department of Radiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Halkali/Istanbul, Turkey.
| | - Omer Bagcilar
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, KMPasa, Istanbul, Turkey
| | - Yeseren Deniz Senli
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, KMPasa, Istanbul, Turkey
| | - Mert Yergin
- Department of Software Engineering and Applied Sciences, Bahcesehir University, Istanbul, Turkey
| | - Cihan Isler
- Department of Neurosurgery, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, KMPasa, Istanbul, Turkey
| | - Naci Kocer
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, KMPasa, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, KMPasa, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, KMPasa, Istanbul, Turkey
| |
Collapse
|
24
|
Dogan SN, Bagcilar O, Mammadov T, Kizilkilic O, Islak C, Kocer N. De Novo Development of a Cerebral Arteriovenous Malformation: Case Report and Review of the Literature. World Neurosurg 2019; 126:257-260. [DOI: 10.1016/j.wneu.2019.02.226] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/24/2019] [Accepted: 02/25/2019] [Indexed: 12/21/2022]
|
25
|
Korkmazer B, Kocak B, Islak C, Kocer N, Kizilkilic O. Long-term results of flow diversion in the treatment of intracranial aneurysms: a retrospective data analysis of a single center. Acta Neurochir (Wien) 2019; 161:1165-1173. [PMID: 31037497 DOI: 10.1007/s00701-019-03912-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 04/13/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Endovascular techniques are frequently used for the treatment of intracranial aneurysms and flow diverter stents are relatively new and important devices in this field. The aim of our study is to report long-term follow-up results of flow diversion treatment. METHODS We retrospectively examined angiographic images and clinical reports of 133 patients (female, 112 [84%]; mean age, 46.3 years [range, 12-70 years]) who were treated with flow diverters between 2008 and 2013 and were followed up radiologically at least 1 year. The aneurysms treated with flow diverters were assessed according to technical problems, stent patency, residual filling, re-growth, and occlusion status, and the patients were assessed according to morbidity and mortality. RESULTS Except for ten patients, one aneurysm was treated per patient. Median duration of the follow-up was 927 days. Total occlusion rates in angiographic follow-up were found 76.2% for the sixth-month, 86.7% for the first-year, 93.6% for the third-year, 94.2% for the fifth-year, and 90.2% for entire follow-up period. Nine stent morphology changes were observed in the angiographic controls. Overall mortality and morbidity rates were 3.7% and 4.3%, respectively. CONCLUSION Despite technical difficulties and delayed hemorrhages, flow diverter stents are effective tools for the treatment of challenging aneurysms in the long run. Nonetheless, long-term results of flow diversion treatment must be evaluated hemodynamically and clinically in multicenter studies.
Collapse
Affiliation(s)
- Bora Korkmazer
- Department of Radiology, Canakkale Mehmet Akif Ersoy State Hospital, Canakkale, Turkey
| | - Burak Kocak
- Department of Radiology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, 34098, Istanbul, Turkey
| | - Naci Kocer
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, 34098, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, 34098, Istanbul, Turkey.
| |
Collapse
|
26
|
Zeynalova A, Kocak B, Durmaz ES, Comunoglu N, Ozcan K, Ozcan G, Turk O, Tanriover N, Kocer N, Kizilkilic O, Islak C. Preoperative evaluation of tumour consistency in pituitary macroadenomas: a machine learning-based histogram analysis on conventional T2-weighted MRI. Neuroradiology 2019; 61:767-774. [PMID: 31011772 DOI: 10.1007/s00234-019-02211-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/03/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the potential value of machine learning (ML)-based histogram analysis (or first-order texture analysis) on T2-weighted magnetic resonance imaging (MRI) for predicting consistency of pituitary macroadenomas (PMA) and to compare it with that of signal intensity ratio (SIR) evaluation. METHODS Fifty-five patients with 13 hard and 42 soft PMAs were included in this retrospective study. Histogram features were extracted from coronal T2-weighted original, filtered and transformed MRI images by manual segmentation. To achieve balanced classes (38 hard vs 42 soft), multiple samples were obtained from different slices of the PMAs with hard consistency. Dimension reduction was done with reproducibility analysis, collinearity analysis and feature selection. ML classifier was artificial neural network (ANN). Reference standard for the classifications was based on surgical and histopathological findings. Predictive performance of histogram analysis was compared with that of SIR evaluation. The main metric for comparisons was the area under the receiver operating characteristic curve (AUC). RESULTS Only 137 of 162 features had excellent reproducibility. Collinearity analysis yielded 20 features. Feature selection algorithm provided six texture features. For histogram analysis, the ANN correctly classified 72.5% of the PMAs regarding consistency with an AUC value of 0.710. For SIR evaluation, accuracy and AUC values were 74.5% and 0.551, respectively. Considering AUC values, ML-based histogram analysis performed better than SIR evaluation (z = 2.312, p = 0.021). CONCLUSION ML-based T2-weighted MRI histogram analysis might be a useful technique in predicting the consistency of PMAs, with a better predictive performance than that of SIR evaluation.
Collapse
Affiliation(s)
- Amalya Zeynalova
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Burak Kocak
- Department of Radiology, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Emine Sebnem Durmaz
- Department of Radiology, Buyukcekmece Mimar Sinan State Hospital, Istanbul, Turkey
| | - Nil Comunoglu
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kerem Ozcan
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gamze Ozcan
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Okan Turk
- Department of Neurosurgery, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Necmettin Tanriover
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Naci Kocer
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
27
|
Durmaz ES, Kocak B, Kadioglu P, Comunoglu N, Ulu MO, Kocer N, Islak C, Kizilkilic O. Added Value of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Predicting Response to Somatostatin Analogs in Acromegaly Patients. Turk Neurosurg 2019; 29:835-842. [PMID: 30900736 DOI: 10.5137/1019-5149.jtn.26003-19.1] [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: 10/27/2022]
Abstract
AIM To investigate the added value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) sequences in predicting somatostatin analog (SSA) responses in patients with acromegaly. MATERIAL AND METHODS This study included 55 active acromegaly patients with macroadenoma. Mean and maximum signal intensities were measured using region of interests in T2-weighted (T2W) and DCE-MRI sequences. Semi-quantitative values indicating relative signal intensity ratios and contrast-enhanced kinetics were obtained. Bivariate and multivariate analyses were used to determine whether the pathological granulation pattern of adenomas (dense versus others) was associated with patients' demographic variables and semi-quantitative MRI parameters. RESULTS Three parameters formed the logistic model, x2(3)=23.278, p < 0.0001: age (odds ratio [OR]=1.08), hypointensity of adenomas in T2W images (OR=15.45), and high maximum enhancement ratio in the second interval (ER2max) values (OR=2195.74). The overall accuracy of this model was 85.45% with an area under the curve of 0.880. Sensitivity, specificity, positive predictive, and negative predictive values of the model were 68.75%, 92.31%, 78.58%, and 87.8%, respectively. CONCLUSION In patients with newly diagnosed acromegaly, the model created based on the relative T2W signal intensity, patient's age, and ER2 < submax parameter from DCE-MRI sequences might be used to more accurately predict SSA responses.
Collapse
Affiliation(s)
- Emine Sebnem Durmaz
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Radiology, Istanbul, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Alis D, Alis C, Tutuncu M, Kocer N, Islak C, Kizilkilic O. Apparent diffusion coefficient characteristics of parenchymal neuro-Behçet's disease. Int J Rheum Dis 2019; 22:1452-1458. [PMID: 30860316 DOI: 10.1111/1756-185x.13542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 01/31/2019] [Accepted: 02/14/2019] [Indexed: 01/30/2023]
Abstract
AIM To evaluate apparent diffusion coefficient (ADC) characteristic of parenchymal neuro-Behçet's disease (NBD). METHODS We retrospectively reviewed cranial magnetic resonance imaging (MRI) examinations of NBD patients with acute or chronic parenchymal lesions. ADC measurements of the lesions and contralateral normal brain parenchyma were performed by a consensus of two radiologists. To compare the ADC value of the chronic and acute lesions, relative ADC values (rADC) were calculated. The ratio of the lesions' ADC to contralateral normal brain parenchyma ADC yielded a rADC value of the lesions. Contrast enhancement patterns and the locations of the lesions were also noted. RESULTS A total of 24 NBD patients with 45 parenchymal lesions, 25 acute, and 20 chronic, were enrolled in the study. A significant difference was observed between the mean ADC value of the acute lesions (1074.48 ± 138.31 m/s) and the mean ADC value of the contralateral normal brain parenchyma (841.20 ± 142.96 m/s; P < 0.0001). A significant difference was observed between the mean ADC value of the chronic lesions (1069.95 ± 143.95 m/s) and the mean ADC value of the contralateral normal brain parenchyma (793.90 ± 96.71 m/s; P < 0.0001). No significant difference was observed between the mean rADC (1.35 ± 0.20) and the mean rADC value of the chronic lesions (1.29 ± 0.15; P = 0.22). CONCLUSIONS ADC measurements might provide substantial information about the histopathological aspect of parenchymal NBD lesions.
Collapse
Affiliation(s)
- Deniz Alis
- Department of Radiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Halkali/Istanbul, Turkey
| | - Ceren Alis
- Cerrahpasa Faculty of Medicine, Department of Neurology, Istanbul University, Istanbul, Turkey
| | - Melih Tutuncu
- Cerrahpasa Faculty of Medicine, Department of Neurology, Istanbul University, Istanbul, Turkey
| | - Naci Kocer
- Cerrahpasa Faculty of Medicine, Department of Radiology, Istanbul University, Istanbul, Turkey
| | - Civan Islak
- Cerrahpasa Faculty of Medicine, Department of Radiology, Istanbul University, Istanbul, Turkey
| | - Osman Kizilkilic
- Cerrahpasa Faculty of Medicine, Department of Radiology, Istanbul University, Istanbul, Turkey
| |
Collapse
|
29
|
Islak C, Kocer N. Imaging of Vascular Disorders of the Spine and Spinal Cord. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-68536-6_42] [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: 10/26/2022]
|
30
|
Bakan S, Alis D, Alis C, Kizilkilic O, Kocer N, Islak C. Reversible cerebellar herniation after epidural blood patch in a patient with spontaneous intracranial hypotension. Diagn Interv Imaging 2018; 100:127-128. [PMID: 30522910 DOI: 10.1016/j.diii.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/08/2018] [Accepted: 11/10/2018] [Indexed: 11/15/2022]
Affiliation(s)
- S Bakan
- Department of Radiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - D Alis
- Department of Radiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Halkali, Istanbul, Turkey.
| | - C Alis
- Department of Neurology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - O Kizilkilic
- Department of Radiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - N Kocer
- Department of Radiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - C Islak
- Department of Radiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| |
Collapse
|
31
|
Alis D, Durmaz ESM, Civcik C, Tutuncu M, Saip S, Kocer N, Islak C, Kizilkilic O. Assessment of the common carotid artery wall stiffness by Shear Wave Elastography in Behcet's disease. Med Ultrason 2018; 20:446-452. [PMID: 30534651 DOI: 10.11152/mu-1565] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM To evaluate endothelial dysfunction and subclinical atherosclerosis in Behcet's disease (BD) by measuring the common carotid artery (CCA) wall stiffness and carotid intima-media thickness (CIMT). MATERIALS AND METHODS We prospectively evaluated CIMT and the CCA wall stiffness of 34 BD patients and 28 age/sex-matched controls. CIMT measurements were performed from the posterior wall of the carotid artery approximately 10 mm proximal to the initiation of the carotid bulb using B-mode ultrasound. The stiffness of the CCA was measured from the superficial wall of the CCA using shear wave elastography (SWE). SWE measurements were recorded as shear wave velocity (SWV) using m/s as a unit. RESULTS The mean right (0.5±0.11 mm) and left (0.5±0.14 mm) CIMT of the patients were significantly higher compared to the mean right (0.41±0.07 mm) and left (0.41±0.11 mm) CIMT of the healthy controls (p=0.001 and p= 0.003 respectively). The mean right (3.72±0.94 m/s) and left (3.57±0.72 m/s) CCA wall stiffness of the patients were significantly higher compared to the mean right (2.42±0.49 m/s) and left (2.56±0.49 m/s) CCA wall stiffness of the controls (p<0.001 for both). CONCLUSIONS SWE seems to be a promising modality to evaluate endothelial dysfunction in BD by interpreting the arterial stiffness, and SWE might be an important adjunct to clinical and laboratory findings, and imaging modalities to assess cardiovascular risk in BD. Moreover, SWE evaluation of the arterial stiffness might assist us to understand pathophysiological aspects of BD.
Collapse
Affiliation(s)
- Deniz Alis
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Radiology, KMPasa, Istanbul, Turkey..
| | - Emine Sebnem Memis Durmaz
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Radiology, KMPasa, Istanbul, Turkey..
| | - Ceren Civcik
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Neurology, KMPasa, Istanbul, Turkey..
| | - Melih Tutuncu
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Neurology, KMPasa, Istanbul, Turkey..
| | - Sabahattin Saip
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Neurology, KMPasa, Istanbul, Turkey..
| | - Naci Kocer
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Radiology, KMPasa, Istanbul, Turkey..
| | - Civan Islak
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Radiology, KMPasa, Istanbul, Turkey..
| | - Osman Kizilkilic
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Radiology, KMPasa, Istanbul, Turkey..
| |
Collapse
|
32
|
Kocak B, Durmaz ES, Kadioglu P, Polat Korkmaz O, Comunoglu N, Tanriover N, Kocer N, Islak C, Kizilkilic O. Predicting response to somatostatin analogues in acromegaly: machine learning-based high-dimensional quantitative texture analysis on T2-weighted MRI. Eur Radiol 2018; 29:2731-2739. [PMID: 30506213 DOI: 10.1007/s00330-018-5876-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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: 07/09/2018] [Revised: 10/10/2018] [Accepted: 11/07/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the value of machine learning (ML)-based high-dimensional quantitative texture analysis (qTA) on T2-weighted magnetic resonance imaging (MRI) in predicting response to somatostatin analogues (SA) in acromegaly patients with growth hormone (GH)-secreting pituitary macroadenoma, and to compare the qTA with quantitative and qualitative T2-weighted relative signal intensity (rSI) and immunohistochemical evaluation. METHODS Forty-seven patients (24 responsive; 23 resistant patients to SA) were eligible for this retrospective study. Coronal T2-weighted images were used for qTA and rSI evaluation. The immunohistochemical evaluation was based on the granulation pattern of the adenomas. Dimension reduction was carried out by reproducibility analysis and wrapper-based algorithm. ML classifiers were k-nearest neighbours (k-NN) and C4.5 algorithm. The reference standard was the biochemical response status. Predictive performance of qTA was compared with those of the quantitative and qualitative rSI and immunohistochemical evaluation. RESULTS Five hundred thirty-five out of 828 texture features had excellent reproducibility. For the qTA, k-NN correctly classified 85.1% of the macroadenomas regarding response to SAs with an area under the receiver operating characteristic curve (AUC-ROC) of 0.847. The accuracy and AUC-ROC ranges of the other methods were 57.4-70.2% and 0.575-0.704, respectively. Differences in predictive performance between qTA-based classification and the other methods were significant (p < 0.05). CONCLUSIONS The ML-based qTA of T2-weighted MRI is a potential non-invasive tool in predicting response to SAs in patients with acromegaly and GH-secreting pituitary macroadenoma. The method performed better than the qualitative and quantitative rSI and immunohistochemical evaluation. KEY POINTS • Machine learning-based texture analysis of T2-weighted MRI can correctly classify response to somatostatin analogues in more than four fifths of the patients. • Machine learning-based texture analysis performs better than qualitative and quantitative evaluation of relative T2 signal intensity and immunohistochemical evaluation. • About one third of the texture features may not be excellently reproducible, indicating that a reliability analysis is necessary before model development.
Collapse
Affiliation(s)
- Burak Kocak
- Department of Radiology, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Emine Sebnem Durmaz
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Pinar Kadioglu
- Department of Endocrinology and Metabolism, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozge Polat Korkmaz
- Department of Endocrinology and Metabolism, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nil Comunoglu
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Necmettin Tanriover
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Naci Kocer
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
33
|
Kocer N, Kandemirli SG, Dashti R, Kizilkilic O, Hanimoglu H, Sanus GZ, Tunali Y, Tureci E, Islak C, Kaynar MY. Single-stage planning for total cure of grade III-V brain arteriovenous malformations by embolization alone or in combination with microsurgical resection. Neuroradiology 2018; 61:195-205. [PMID: 30488257 DOI: 10.1007/s00234-018-2140-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 03/27/2018] [Accepted: 11/16/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE There are no established guidelines for treatment of Spetzler-Martin grade III-V brain arteriovenous malformations (bAVMs). The purpose of this study is to report our institutional experience in total obliteration/eradication of grade III-V bAVMs by single-stage planning of embolization combined with microsurgical resection when necessary. METHODS All patients harboring Spetzler-Martin (S-M) grade III-V bAVMs treated with single-stage planning between January 2006 and January 2018 were retrospectively reviewed. This treatment paradigm is applicable only to surgically accessible bAVMs and does not include deep-seated bAVMs. Indications for treatment, clinical presentation, imaging characteristics, and treatment outcomes were analyzed. Outcomes were assessed based on modified Rankin Scale. RESULTS A total of 31 patients were identified. Seventeen patients (54.8%) presented with hemorrhage, 10 (32.3%) with seizures, 3 (9.7%) with headaches, and 1 (3.2%) with progressive neurological deficit. Based on S-M grading system, 25 patients (80.6%) harbored grade III bAVM, 5 patients had grade IV bAVMs (16.1%), and 1 patient (3.2%) had a grade V bAVM. There were no treatment-related complications in 24/31 (77.4%) patients. Of the total of seven patients with complications, four patients had clinical deterioration. The long-term (> 6-month), non-disabling morbidity (mRS ≤ 2) rate was 6.5%. The long-term, disabling morbidity rate was 3.2% with a mortality of 3.2%. Complete angiographic obliteration was achieved in 30/31 (96.8%) patients. CONCLUSION Single-stage treatment strategy can be considered as an alternative to multistage embolization prior to surgery in grade III-V bAVMs. In this study, a high rate of total obliteration with relatively low rates of permanent morbidity and mortality was achieved.
Collapse
Affiliation(s)
- Naci Kocer
- Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, 34098, Istanbul, Turkey.
| | - Sedat Giray Kandemirli
- Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, 34098, Istanbul, Turkey
| | - Reza Dashti
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Osman Kizilkilic
- Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, 34098, Istanbul, Turkey
| | - Hakan Hanimoglu
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Galip Zihni Sanus
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Yusuf Tunali
- Department of Anesthesiology and Reanimation, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ercan Tureci
- Department of Anesthesiology and Reanimation, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Civan Islak
- Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, 34098, Istanbul, Turkey
| | - Mehmet Yasar Kaynar
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| |
Collapse
|
34
|
Kandemirli SG, Cekirge S, Oran I, Saatci I, Kizilkilic O, Cinar C, Islak C, Kocer N. Intracranial Serpentine Aneurysms: Spontaneous Changes of Angiographic Filling Pattern. AJNR Am J Neuroradiol 2018; 39:1662-1668. [PMID: 30139757 DOI: 10.3174/ajnr.a5746] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/12/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND PURPOSE Serpentine aneurysms are partially thrombosed aneurysms with an eccentrically located tortuous intra-aneurysmal vascular channel. The large size, distinctive neck anatomy, and supply of the brain parenchyma by the outflow tract pose technical challenges in treatment. The aim of this study was to discuss the endovascular treatment results and illustrate the dynamic nature of serpentine aneurysms. Spontaneous transformation of saccular and fusiform aneurysms into serpentine morphology, along with a case of serpentine-into-fusiform aneurysm transformation during follow-up, is presented. MATERIALS AND METHODS A retrospective analysis from 3 institutions revealed 15 patients with serpentine aneurysms who underwent diagnostic evaluation and endovascular treatment. Nine of the 15 patients underwent endovascular occlusion of the parent vessel with detachable balloon or coils. Six of the 15 patients underwent aneurysm and parent artery occlusion with coiling. RESULTS In 11 patients, improvement or resolution of symptoms was achieved by an endovascular approach without any treatment-related morbidity. Morbidity related to treatment in the immediate postoperative period was seen in 3 patients, with resolution of the deficits at long-term follow-up in 2 patients and persistence of a mild deficit in 1 patient. Endovascular treatment failed to achieve resolution of symptoms in a case with a basilar tip aneurysm treated by aneurysm coiling. CONCLUSIONS Serpentine aneurysms are dynamic structures with spontaneous transformation possible from a saccular or fusiform shape into a serpentine configuration. An endovascular approach by parent vessel occlusion or intra-aneurysmal occlusion is a successful treatment technique for serpentine aneurysms.
Collapse
Affiliation(s)
- S G Kandemirli
- From the Division of Neuroradiology (S.G.K., O.K., C.I., N.K.), Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - S Cekirge
- Interventional Neuroradiology Department (S.C.), Koru and Bayındır Hospital, Ankara, Turkey.,Interventional Neuroradiology Department (S.C., I.S.), Yuksek Ihtisas University, Koru Hospital, Ankara, Turkey
| | - I Oran
- Division of Neuroradiology (I.O., C.C.), Department of Radiology, Ege University Medical Faculty, İzmir, Turkey
| | - I Saatci
- Interventional Neuroradiology Department (S.C., I.S.), Yuksek Ihtisas University, Koru Hospital, Ankara, Turkey
| | - O Kizilkilic
- From the Division of Neuroradiology (S.G.K., O.K., C.I., N.K.), Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - C Cinar
- Division of Neuroradiology (I.O., C.C.), Department of Radiology, Ege University Medical Faculty, İzmir, Turkey
| | - C Islak
- From the Division of Neuroradiology (S.G.K., O.K., C.I., N.K.), Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - N Kocer
- From the Division of Neuroradiology (S.G.K., O.K., C.I., N.K.), Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| |
Collapse
|
35
|
Nacar Dogan S, Kizilkilic O, Kocak B, Isler C, Islak C, Kocer N. Intrathecal gadolinium-enhanced MR cisternography in patients with otorhinorrhea: 10-year experience of a tertiary referral center. Neuroradiology 2018; 60:471-477. [PMID: 29572604 DOI: 10.1007/s00234-018-2014-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/13/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Despite a considerable amount of literature that has been published about the use of intrathecal gadolinium-enhanced MR cisternography (IGE-MRC), there is still relatively lack of evidence as to its long-term effects. Our purpose in this study was twofold: firstly, to assess the long-term safety of the IGE-MRC; secondly, to evaluate the diagnostic performance of IGE-MRC for detecting cerebrospinal fluid (CSF) leak in otorhinorrhea patients. METHODS We retrospectively reviewed our imaging and clinical database for the patients admitted to our department for the evaluation of their otorhinorrhea between 2008 and 2017. Two radiologists evaluated the imaging studies independently. Consensus data was used in the analysis. Medical record review and phone call were used for the long-term follow-up. RESULTS The retrospective review yielded 166 patients. Rhinorrhea was present in 150 (90.4%) patients and otorrhea in 16 (9.6%) patients. Overall, 67 patients (40.5% of all patients) underwent operation for repair of the CSF leak site. Beta-transferrin test was available and positive in 57 (34.3%) patients. Overall sensitivity of IGE-MRC and paranasal high-resolution CT (HRCT) was 89.3 and 72%, respectively. Within the first 24 h after the procedure, none of the patients experienced a significant complication or adverse reaction. Ninety-nine patients (59.6%) had medical record and telephone follow-up. The mean follow-up duration with call was 37.1 months. Three (3%) patients complained about severe headache 3-4 weeks after the procedure. CONCLUSIONS IGE-MRC is a minimally invasive and highly sensitive imaging technique. No adverse side effect during our long-term follow-up might strengthen and support the safety of IGE-MRC.
Collapse
Affiliation(s)
- Sebahat Nacar Dogan
- Department of Radiology, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Division of Neuroradiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.
| | - Burak Kocak
- Department of Radiology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Cihan Isler
- Department of Neurosurgery, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Division of Neuroradiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Naci Kocer
- Department of Radiology, Division of Neuroradiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| |
Collapse
|
36
|
Killer-Oberpfalzer M, Kocer N, Griessenauer CJ, Janssen H, Engelhorn T, Holtmannspötter M, Buhk JH, Finkenzeller T, Fesl G, Trenkler J, Reith W, Berlis A, Hausegger K, Augustin M, Islak C, Minnich B, Möhlenbruch M. European Multicenter Study for the Evaluation of a Dual-Layer Flow-Diverting Stent for Treatment of Wide-Neck Intracranial Aneurysms: The European Flow-Redirection Intraluminal Device Study. AJNR Am J Neuroradiol 2018; 39:841-847. [PMID: 29545252 DOI: 10.3174/ajnr.a5592] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/12/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Endoluminal reconstruction with flow-diverting stents represents a widely accepted technique for the treatment of complex intracranial aneurysms. This European registry study analyzed the initial experience of 15 neurovascular centers with the Flow-Redirection Intraluminal Device (FRED) system. MATERIALS AND METHODS Consecutive patients with intracranial aneurysms treated with the FRED between February 2012 and March 2015 were retrospectively reviewed. Complications and adverse events, transient and permanent morbidity, mortality, and occlusion rates were evaluated. RESULTS During the defined study period, 579 aneurysms in 531 patients (median age, 54 years; range, 13-86 years) were treated with the FRED. Seven percent of patients were treated in the acute phase (≤3 days) of aneurysm rupture. The median aneurysm size was 7.6 mm (range, 1-36.6 mm), and the median neck size 4.5 mm (range, 1-30 mm). Angiographic follow-up of >3 months was available for 516 (89.1%) aneurysms. There was progressive occlusion witnessed with time, with complete occlusion in 18 (20%) aneurysms followed for up to 90 ± 14 days, 141 (82.5%) for 180 ± 20 days, 116 (91.3%) for 1 year ± 24 days, and 122 (95.3%) aneurysms followed for >1 year. Transient and permanent morbidity occurred in 3.2% and 0.8% of procedures, respectively. The overall mortality rate was 1.5%. CONCLUSIONS This retrospective study in real-world patients demonstrated the safety and efficacy of the FRED for the treatment of intracranial aneurysms. In most cases, treatment with a single FRED resulted in complete angiographic occlusion at 1 year.
Collapse
Affiliation(s)
- M Killer-Oberpfalzer
- From the Research Institute of Neurointervention/Department of Neurology (M.K.-O., C.J.G.), Paracelsus Medical University, Salzburg, Austria
| | - N Kocer
- Department of Neuroradiology (N.K., C.I.), Cerrahpasa Medical School, Istanbul University, Turkey
| | - C J Griessenauer
- From the Research Institute of Neurointervention/Department of Neurology (M.K.-O., C.J.G.), Paracelsus Medical University, Salzburg, Austria.,Department of Neurosurgery (C.J.G.), Geisinger Health, Danville, Pennsylvania
| | - H Janssen
- Institute of Radiology and Neuroradiology (H.J., T.F.), Klinikum Nuernberg Sued, Paracelsus Medical University, Nuernberg, Germany
| | - T Engelhorn
- Department of Neuroradiology (T.E.), University Hospital, Erlangen, Germany
| | - M Holtmannspötter
- Department of Diagnostic Radiology (M.H.), Rigshospitalet, Copenhagen, Denmark
| | - J H Buhk
- Department of Neuroradiology (J.H.B.), University Hospital Hamburg, Eppendorf, Germany
| | - T Finkenzeller
- Institute of Radiology and Neuroradiology (H.J., T.F.), Klinikum Nuernberg Sued, Paracelsus Medical University, Nuernberg, Germany
| | - G Fesl
- Department of Neuroradiology (G.F.), Klinikum Grosshadern, University of Munich, Munich, Germany
| | - J Trenkler
- Department of Neuroradiology (J.T.), Kepler Universitätsklinikum, Linz, Austria
| | - W Reith
- Klinik für Diagnostische und Interventionelle Neuroradiologie (W.R.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - A Berlis
- Klinik für Diagnostische Radiologie und Neuroradiologie (A.B.), Klinikum Augsburg, Augsburg, Germany
| | - K Hausegger
- Department of Diagnostic and Interventional Radiology (K.H.), Klinikum Klagenfurt, Klagenfurt, Austria
| | - M Augustin
- Department of Radiology (M.A.), University Hospital, Graz, Austria
| | - C Islak
- Department of Neuroradiology (N.K., C.I.), Cerrahpasa Medical School, Istanbul University, Turkey
| | - B Minnich
- Department of Cell Biology and Physiology (B.M.), Universität Salzburg, Salzburg, Austria
| | - M Möhlenbruch
- Department of Neuroradiology (M.M.), Universitätsklinikum Heidelberg, Heidelberg, Germany
| |
Collapse
|
37
|
Kocak B, Kizilkilic O, Kocer N, Islak C. Letter to the Editor. Is it time to evaluate multiple familial cavernous malformations with ultra-high resolution flat-detector CT angiography? J Neurosurg 2018; 128:1268-1270. [PMID: 29393760 DOI: 10.3171/2017.7.jns171433] [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)
- Burak Kocak
- 1Aksaray Training and Research Hospital, Aksaray University, Aksaray, Turkey; and
| | - Osman Kizilkilic
- 2Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Naci Kocer
- 2Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Civan Islak
- 2Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| |
Collapse
|
38
|
Islak C, Kandemirli SG, Kizilkilic O, Kocer N, Tuzgen S, Hanci MM. Combined Spinal Arteriovenous Malformation and Spinal Dysraphism. World Neurosurg 2018; 110:407-413. [DOI: 10.1016/j.wneu.2017.11.162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/26/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022]
|
39
|
Alis D, Civcik C, Erol B, Kizilkilic O, Kocer N, Islak C. Flat-detector CT angiography in the evaluation of neuro-Behçet disease. Diagn Interv Imaging 2017. [DOI: 10.1016/j.diii.2017.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
40
|
Kocer N, Mondel PK, Yamac E, Kavak A, Kizilkilic O, Islak C. Is there an association between flow diverter fish mouthing and delayed-type hypersensitivity to metals?-a case-control study. Neuroradiology 2017; 59:1171-1178. [PMID: 28875355 DOI: 10.1007/s00234-017-1910-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Flow diverters are increasingly used in the treatment of complex and giant intracranial aneurysms. However, they are associated with complications like late aneurysmal rupture. Additionally, flow diverters show focal structural decrease in luminal diameter without any intimal hyperplasia. This resembles a "fish mouth" when viewed en face. In this pilot study, we tested the hypothesis of a possible association between flow diverter fish-mouthing and delayed-type hypersensitivity to its metal constituents. METHODS We retrospectively reviewed patient records from our center between May 2010 and November 2015. A total of nine patients had flow diverter fish mouthing. A control group of 25 patients was selected. All study participants underwent prospective patch test to detect hypersensitivity to flow diverter metal constituents. Analysis was performed using logistic regression analysis and Wilcoxon sign rank sum test. Univariate and multivariate analyses were performed to test variables to predict flow diverter fish mouthing. RESULTS The association between flow diverter fish mouthing and positive patch test was not statistically significant. In multivariate analysis, history of allergy and maximum aneurysm size category was associated with flow diverter fish mouthing. This was further confirmed on Wilcoxon sign rank sum test. CONCLUSION The study showed statistically significant association between flow diverter fish mouthing and history of contact allergy and a small aneurysmal size. Further large-scale studies are needed to detect a statistically significant association between flow diverter fish mouthing and patch test. We recommend early and more frequent follow-up imaging in patients with contact allergy to detect flow diverter fish mouthing and its subsequent evolution.
Collapse
Affiliation(s)
- Naci Kocer
- Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, 34098, Istanbul, Turkey.
| | - Prabath Kumar Mondel
- Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, 34098, Istanbul, Turkey
| | - Elif Yamac
- Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, 34098, Istanbul, Turkey
| | - Ayse Kavak
- Department of Dermatology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Tevfik Sağlam Cad. No: 11, Zuhuratbaba Mah., 34147, Bakirköy/Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, 34098, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, 34098, Istanbul, Turkey
| |
Collapse
|
41
|
Möhlenbruch MA, Kizilkilic O, Killer-Oberpfalzer M, Baltacioglu F, Islak C, Bendszus M, Cekirge S, Saatci I, Kocer N. Multicenter Experience with FRED Jr Flow Re-Direction Endoluminal Device for Intracranial Aneurysms in Small Arteries. AJNR Am J Neuroradiol 2017; 38:1959-1965. [PMID: 28798217 DOI: 10.3174/ajnr.a5332] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/24/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flow diverters are emerging as an endovascular treatment alternative for proximally located intracranial aneurysms. However, treatment of aneurysms at and beyond the circle of Willis is not well-established. We assessed the clinical safety and efficacy of the Flow Re-Direction Endoluminal Device Jr (FRED Jr) dedicated to small-vessel diameters between 2.0 and 3.0 mm. MATERIALS AND METHODS This was a multicenter observational clinical study of 42 patients with 47 aneurysms treated by a flow-direction technique with the FRED Jr. The primary end point for clinical safety was the absence of death, major or minor stroke, and TIA. The primary end point for treatment efficacy was complete and near-complete occlusion according to the O'Kelly-Marotta grading scale at follow-up after 1, 6, and 12 months. RESULTS The FRED Jr deployment was technically successful in all cases. In 39/42 (93%) patients, the primary safety end point was reached; in the 3 remaining patients, 1 disabling ischemic stroke, 1 minor stroke with complete recovery at discharge, and 1 TIA were observed. Two asymptomatic, completely reversible side-branch occlusions occurred. Angiographic (DSA or flat panel CT) and clinical follow-up were available after 1 month in 41/47 (87%), 6 months in 27/47 (57%), and 12 months in 11/47 (23%) aneurysms. The primary efficacy end point was reached at 1 month in 27/41 (66%), at 6 months in 21/27 (78%), and at 12 months in 11/11 (100%) aneurysms. CONCLUSIONS Deployment of the FRED Jr is safe and effective in the treatment of intracranial aneurysms located in small vessels.
Collapse
Affiliation(s)
- M A Möhlenbruch
- From the Department of Neuroradiology (M.A.M., M.B.), Heidelberg University Hospital, Heidelberg, Germany
| | - O Kizilkilic
- Department of Neuroradiology (O.K., C.I., N.K.), Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - M Killer-Oberpfalzer
- Department of Neurology/Research Institute of Neurointervention (M.K.-O.), Paracelsus Medical University, Salzburg, Austria
| | - F Baltacioglu
- Department of Radiology (F.B.), Marmara University School of Medicine, Istanbul, Turkey
| | - C Islak
- Department of Neuroradiology (O.K., C.I., N.K.), Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - M Bendszus
- From the Department of Neuroradiology (M.A.M., M.B.), Heidelberg University Hospital, Heidelberg, Germany
| | - S Cekirge
- Department of Radiology (S.C.), Koru and Bayindir Hospital, Ankara, Turkey.,Department of Radiology (S.C., I.S.), Yüksek Ihtisas University, Koru Hospital, Ankara, Turkey
| | - I Saatci
- Department of Radiology (S.C., I.S.), Yüksek Ihtisas University, Koru Hospital, Ankara, Turkey
| | - N Kocer
- Department of Neuroradiology (O.K., C.I., N.K.), Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| |
Collapse
|
42
|
Uygunoglu U, Zeydan B, Ozguler Y, Ugurlu S, Seyahi E, Kocer N, Islak C, Kantarci K, Saip S, Siva A, Kantarci OH. Myelopathy in Behçet's disease: The Bagel Sign. Ann Neurol 2017; 82:288-298. [DOI: 10.1002/ana.25004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Ugur Uygunoglu
- Istanbul University, Cerrahpaşa School of Medicine, Department of Neurology; Istanbul Turkey
- Mayo Clinic College of Medicine, Department of Neurology, Rochester; MN
| | - Burcu Zeydan
- Mayo Clinic College of Medicine, Department of Neurology, Rochester; MN
- Mayo Clinic College of Medicine, Department of Radiology, Rochester; MN
| | - Yesim Ozguler
- Istanbul University, Cerrahpaşa School of Medicine, Department of Rheumatology; Istanbul Turkey
| | - Serdal Ugurlu
- Istanbul University, Cerrahpaşa School of Medicine, Department of Rheumatology; Istanbul Turkey
| | - Emire Seyahi
- Istanbul University, Cerrahpaşa School of Medicine, Department of Rheumatology; Istanbul Turkey
| | - Naci Kocer
- Istanbul University, Cerrahpaşa School of Medicine, Department of Radiology; Istanbul Turkey
| | - Civan Islak
- Istanbul University, Cerrahpaşa School of Medicine, Department of Radiology; Istanbul Turkey
| | - Kejal Kantarci
- Mayo Clinic College of Medicine, Department of Radiology, Rochester; MN
| | - Sabahattin Saip
- Istanbul University, Cerrahpaşa School of Medicine, Department of Neurology; Istanbul Turkey
| | - Aksel Siva
- Istanbul University, Cerrahpaşa School of Medicine, Department of Neurology; Istanbul Turkey
| | - Orhun H. Kantarci
- Mayo Clinic College of Medicine, Department of Neurology, Rochester; MN
| |
Collapse
|
43
|
Cenzato M, Boccardi E, Beghi E, Vajkoczy P, Szikora I, Motti E, Regli L, Raabe A, Eliava S, Gruber A, Meling TR, Niemela M, Pasqualin A, Golanov A, Karlsson B, Kemeny A, Liscak R, Lippitz B, Radatz M, La Camera A, Chapot R, Islak C, Spelle L, Debernardi A, Agostoni E, Revay M, Morgan MK. European consensus conference on unruptured brain AVMs treatment (Supported by EANS, ESMINT, EGKS, and SINCH). Acta Neurochir (Wien) 2017; 159:1059-1064. [PMID: 28389875 DOI: 10.1007/s00701-017-3154-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [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: 02/14/2017] [Accepted: 03/13/2017] [Indexed: 11/30/2022]
Abstract
In December of 2016, a Consensus Conference on unruptured AVM treatment, involving 24 members of the three European societies dealing with the treatment of cerebral AVMs (EANS, ESMINT, and EGKS) was held in Milan, Italy. The panel made the following statements and general recommendations: (1) Brain arteriovenous malformation (AVM) is a complex disease associated with potentially severe natural history; (2) The results of a randomized trial (ARUBA) cannot be applied equally for all unruptured brain arteriovenous malformation (uBAVM) and for all treatment modalities; (3) Considering the multiple treatment modalities available, patients with uBAVMs should be evaluated by an interdisciplinary neurovascular team consisting of neurosurgeons, neurointerventionalists, radiosurgeons, and neurologists experienced in the diagnosis and treatment of brain AVM; (4) Balancing the risk of hemorrhage and the associated restrictions of everyday activities related to untreated unruptured AVMs against the risk of treatment, there are sufficient indications to treat unruptured AVMs grade 1 and 2 (Spetzler-Martin); (5) There may be indications for treating patients with higher grades, based on a case-to-case consensus decision of the experienced team; (6) If treatment is indicated, the primary strategy should be defined by the multidisciplinary team prior to the beginning of the treatment and should aim at complete eradication of the uBAVM; (7) After having considered the pros and cons of a randomized trial vs. a registry, the panel proposed a prospective European Multidisciplinary Registry.
Collapse
Affiliation(s)
- Marco Cenzato
- Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | | | - Ettore Beghi
- Neurology, Methodologist, IRCCS Istituto Mario Negri, Milan, Italy
| | - Peter Vajkoczy
- Neurosurgery, Charitè Universitatetsmedizin, Berlin, Germany
| | - Istvan Szikora
- Neuroradiology, National Institute of NeuroScience, Budapest, Hungary
| | - Enrico Motti
- Radiosurgery, Ospedale Villa Maria di Cotignola, Ravenna, Italy
| | - Luca Regli
- Neurosurgery, UniversitaetsSpital, Zurich, Switzerland
| | | | | | - Andreas Gruber
- Neurosurgery and Neuroradiology, University Hospital, Lintz, Austria
| | | | - Mika Niemela
- Neurosurgery, University Hospital, Helsinki, Finland
| | | | | | - Bengt Karlsson
- Radiosurgery, Singapore Gamma Knife Center, Singapore, Singapore
| | - Andras Kemeny
- Radiosurgery, Thornbury Radiosurgery Centre, Sheffield, UK
| | - Roman Liscak
- Radiosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Bodo Lippitz
- Radiosurgery, Bupa Cromwell Hospital, London, UK
| | | | | | - René Chapot
- Neuroradiology, Krupp Hospital, Hessen, Germany
| | - Civan Islak
- Neuroradiology, Cerrahpaşa Medical Faculty, İstanbul University, Istanbul, Turkey
| | - Laurent Spelle
- Neuroradiology, Bicetre University Hospital, Paris, France
| | | | - Elio Agostoni
- Neurology, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Martina Revay
- Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | |
Collapse
|
44
|
Kocak B, Kizilkilic O, Oz B, Bakkaloglu DV, Isler C, Kocer N, Islak C. Ultra-high-resolution C-arm flat-detector CT angiography evaluation reveals 3-fold higher association rate for sporadic intracranial cavernous malformations and developmental venous anomalies: a retrospective study in consecutive 58 patients with 60 cavernous malformations. Eur Radiol 2016; 27:2629-2639. [DOI: 10.1007/s00330-016-4595-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/29/2016] [Accepted: 08/30/2016] [Indexed: 01/04/2023]
|
45
|
Kizilkilic O, Huseynov E, Kandemirli SG, Kocer N, Islak C. Detection of wall and neck calcification of unruptured intracranial aneurysms with flat-detector computed tomography. Interv Neuroradiol 2016; 22:293-8. [PMID: 26842608 DOI: 10.1177/1591019915626591] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 12/06/2015] [Indexed: 12/24/2022] Open
Abstract
OBJECT Microsurgical clipping is a widely used surgical technique in intracranial aneurysm treatment. It can be difficult in large sized aneurysms, and those with wide necks, thick walls and calcification located in the vicinity of the neck. This study reviewed calcification of the intracranial aneurysm wall and its relation to patient age, gender, location and size of the aneurysm. A possible cut-off value after which the aneurysm calcification rate increases was also investigated to classify patients' risk factors for microclipping. METHODS A retrospective review of all unruptured intracranial aneurysms that underwent digital subtraction angiography at a single centre was performed. Flat-detector computed tomography images of the aneurysm were reviewed for aneurysm location, size and calcification. The independent samples t test and χ(2) test were used to show the relation between aneurysm wall calcification and patient age, gender, aneurysm localisation and size. RESULTS None of the reviewed factors were statistically significantly related to aneurysm calcification except aneurysm size (P < 0.01). Receiver operating characteristic curves showed aneurysms greater than 10.5 mm could be predicted to be calcified with a sensitivity of 80% and specificity of 63%. CONCLUSION In this study, the presence of calcification was related to aneurysm size. Larger aneurysms were more likely to be calcified. Aneurysms greater than 10.5 mm should be further investigated with a modality such as flat-detector computed tomography to show the calcification in detail, especially if microclipping is considered.
Collapse
Affiliation(s)
| | | | | | - Naci Kocer
- Division of Neuroradiology, Istanbul University, Turkey
| | - Civan Islak
- Division of Neuroradiology, Istanbul University, Turkey
| |
Collapse
|
46
|
Velioglu M, Selcuk H, Kizilkilic O, Basekim C, Kocer N, Islak C. Endovascular Management of Superior Cerebellar Artery Aneurysms: Mid and Long-Term Results. Turk Neurosurg 2015; 25:526-31. [PMID: 26242327 DOI: 10.5137/1019-5149.jtn.8611-13.0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
AIM Superior cerebellar artery (SCA) aneurysms are uncommon vascular lesions, thus data about their presentation and clinical management are limited. Our aim was to determine clinical presentation, angiographic findings and mid and long-term clinical and imaging results of endovascular treatment of 49 patients with SCA aneurysm. MATERIAL AND METHODS Forty-nine patients with SCA aneurysms underwent endovascular treatment (25 female, 24 male; mean age 46.7 years; range, 21-79 years) in our institution. Both aneurysms arising at the origin of SCA and peripheral SCA aneurysms were included to our retrospective study. 73.5% of the patients were presented with subarachnoid hemorrhage. Forty-two of 49 (85.7%) aneurysms were located in the origin of SCA. Mean aneurysm size was 6.5 mm (range 2-16 mm). RESULTS Forty-seven (95.9%) of the aneurysms were coiled with detachable coils. In two peripheral aneurysms, liquid embolic agent was used. Overall control angiographic occlusion rates were as follows: 87.5% (34/40) total occlusion and 12.5% (6/40) dog-ear remnant. All peripheral SCA aneurysms were occluded with the parent artery. Procedure related mortality was seen in one patient (2%) due to the rupture of another aneurysm. There was no procedure related permanent morbidity. CONCLUSION Endovascular treatment is an effective and safe option in both peripheral and proximal SCA aneurysms.
Collapse
Affiliation(s)
- Murat Velioglu
- Girne Military Hospital, Department of Radiology, Girne, Turkish Republic of Northern Cyprus
| | | | | | | | | | | |
Collapse
|
47
|
Saglam M, Anagnostakou V, Kocer N, Islak C, Kizilkilic O. Teaching NeuroImages: A rare cause of trigeminal neuralgia: Dysplastic venous aneurysm of dural arteriovenous fistula. Neurology 2015; 84:e128-9. [DOI: 10.1212/wnl.0000000000001530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
48
|
Kosker M, Sener D, Kilic O, Hasiloglu ZI, Islak C, Kafadar A, Batur S, Oz B, Cokugras H, Akcakaya N, Camcioglu Y. Primary diffuse leptomeningeal gliomatosis mimicking tuberculous meningitis. J Child Neurol 2014; 29:NP171-5. [PMID: 24284232 DOI: 10.1177/0883073813509121] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary diffuse leptomeningeal gliomatosis is a disease with an aggressive course that can result in death. To date, 82 cases have been reported. Here, the case of a 3-year-old male patient presenting with strabismus, headache, and restlessness is reported. Physical examination revealed paralysis of the left abducens nerve, neck stiffness, and bilateral papilledema. Tuberculous meningitis was tentatively diagnosed, and antituberculosis treatment was initiated when cranial imaging revealed contrast enhancement around the basal cistern. Craniocervical magnetic resonance imaging (MRI) was performed when there was no response to treatment, and it revealed diffuse leptomeningeal contrast enhancement around the basilar cistern, in the supratentorial and infratentorial compartments, and in the spinal region. Primary diffuse leptomeningeal gliomatosis was diagnosed by a meningeal biopsy.
Collapse
Affiliation(s)
- Muhammet Kosker
- Division of Infectious Diseases, Clinical Immunology and Allergy, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Dicle Sener
- Division of Infectious Diseases, Clinical Immunology and Allergy, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Omer Kilic
- Division of Infectious Diseases, Clinical Immunology and Allergy, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Zehra Isik Hasiloglu
- Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Civan Islak
- Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ali Kafadar
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sebnem Batur
- Division of Neuropathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Buge Oz
- Division of Neuropathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Haluk Cokugras
- Division of Neuropathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Necla Akcakaya
- Division of Infectious Diseases, Clinical Immunology and Allergy, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Yildiz Camcioglu
- Division of Infectious Diseases, Clinical Immunology and Allergy, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| |
Collapse
|
49
|
Islak C, Kizilkilic O, Kocak B, Saglam M, Yildiz B, Kocer N. Use of buddy wire to facilitate Y-configured stent placement in middle cerebral artery bifurcation aneurysms with daughter branches arising from the sac: a technical note. Neurosurgery 2014; 10 Suppl 1:E167-71; discussion E171. [PMID: 23921705 DOI: 10.1227/neu.0000000000000130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Endovascular treatment of geometrically complex bifurcation aneurysms using a standard Y-configured stenting technique might be extremely difficult, particularly in aneurysms with daughter branches that acutely arise from the aneurysm sac itself. In those cases, deployment of the second stent through interstices of the first stent could be troublesome because of untoward angular changes in the vascular bifurcation prompted by angular changes resulting from placement of the first stent. Here, we describe a novel application of the buddy wire technique to facilitate Y-configured stenting in middle cerebral artery (MCA) bifurcation aneurysms with unfavorable anatomic configuration. CLINICAL PRESENTATION A 60-year-old man with a left-sided MCA bifurcation aneurysm was treated using the buddy wire technique. In addition to the standard Y-configured stenting procedure, we also inserted a 0.014-inch exchange microguidewire into the superior daughter branch, which more acutely emanated from the sac, to attain a favorable bifurcation configuration before deployment of the stents in the Y configuration. The new technique was successful, and the postprocedural course of the treatment was uneventful. CONCLUSION Use of a buddy wire in MCA bifurcation aneurysms with unfavorable anatomic configurations may be a promising method to facilitate Y-configured stent placement.
Collapse
Affiliation(s)
- Civan Islak
- Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa-Istanbul, Turkey
| | | | | | | | | | | |
Collapse
|
50
|
Kocer N, Islak C, Kizilkilic O, Kocak B, Saglam M, Tureci E. Flow Re-direction Endoluminal Device in treatment of cerebral aneurysms: initial experience with short-term follow-up results. J Neurosurg 2014; 120:1158-71. [PMID: 24628615 DOI: 10.3171/2014.1.jns131442] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Flow diverter (FD) stents are relatively new and important devices in the treatment of cerebral aneurysms. The Flow Re-Direction Endoluminal Device has been recently released for clinical use. The authors' aim in this paper is to report their initial single-center FRED experience with short-term results.
Methods
Between February 2012 and May 2013, 33 patients with 37 aneurysms (35 unruptured and 2 previously ruptured aneurysms) were treated with the FRED. Clinical and radiological data of the patients were retrospectively reviewed.
Results
In all patients only 1 device was used without any additional device or material, such as a stent or coil. All procedures were successfully performed. The procedural complication rate was 3% (1 of 33). Thirty patients underwent clinical and radiological follow-up. During the follow-up period, changes in stent morphology, such as “fish mouth” and “foreshortening” phenomena, occurred in 5 patients. The mortality and permanent morbidity rates were 0%. The complete occlusion rates were 32% (6 of 19) at 0–1 month, 67% (8 of 12) at 2–3 months, 80% (4 of 5) at 4–6 months, and 100% (8 of 8) at 7–12 months. The rates for some aneurysms were assessed at more than one time point.
Conclusions
The FRED has an ability to serve neurointerventionalists in the treatment of cerebral aneurysms with its different technical advantages. The occlusion rates with FRED are similar to those with other FD devices. However, these short-term results need to be confirmed with mid- and long-term follow-up results of multicenter large series.
Collapse
Affiliation(s)
- Naci Kocer
- 1Division of Neuroradiology, Department of Radiology, and
| | - Civan Islak
- 1Division of Neuroradiology, Department of Radiology, and
| | | | - Burak Kocak
- 1Division of Neuroradiology, Department of Radiology, and
| | - Muzaffer Saglam
- 2Department of Radiology, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Ercan Tureci
- 3Department of Anesthesiology and Reanimation, Cerrahpasa Medical Faculty, Istanbul University; and
| |
Collapse
|