1
|
Chen M, Joshi KC, Kolb B, Sitton CW, Pujara DK, Abraham MG, Ortega-Gutierrez S, Kasner SE, Hussain SM, Churilov L, Blackburn S, Sundararajan S, Hu YC, Herial N, Arenillas JF, Tsai JP, Budzik RF, Hicks W, Kozak O, Yan B, Cordato D, Manning NW, Parsons M, Hanel RA, Aghaebrahim A, Wu T, Cardona Portela P, Gandhi CD, Al-Mufti F, Perez de la Ossa N, Schaafsma J, Blasco J, Sangha N, Warach S, Kleinig TJ, Johns H, Shaker F, Abdulrazzak MA, Ray A, Sunshine J, Opaskar A, Duncan KR, Xiong W, Al-Shaibi FK, Samaniego EA, Nguyen TN, Fifi JT, Tjoumakaris SI, Jabbour P, Mendes Pereira V, Lansberg MG, Sila C, Bambakidis NC, Davis S, Wechsler L, Albers GW, Grotta JC, Ribo M, Hassan AE, Campbell B, Hill MD, Sarraj A. Clinical relevance of intracranial hemorrhage after thrombectomy versus medical management for large core infarct: a secondary analysis of the SELECT2 randomized trial. J Neurointerv Surg 2024:jnis-2023-021219. [PMID: 38471760 DOI: 10.1136/jnis-2023-021219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/18/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The incidence of intracerebral hemorrhage (ICH) and its effect on the outcomes after endovascular thrombectomy (EVT) for patients with large core infarcts have not been well-characterized. METHODS SELECT2 trial follow-up imaging was evaluated using the Heidelberg Bleeding Classification (HBC) to define hemorrhage grade. The association of ICH with clinical outcomes and treatment effect was examined. RESULTS Of 351 included patients, 194 (55%) and 189 (54%) demonstrated intracranial and intracerebral hemorrhage, respectively, with a higher incidence in EVT (134 (75%) and 130 (73%)) versus medical management (MM) (60 (35%) and 59 (34%), both P<0.001). Hemorrhagic infarction type 1 (HBC=1a) and type 2 (HBC=1b) accounted for 93% of all hemorrhages. Parenchymal hematoma (PH) type 1 (HBC=1c) and type 2 (HBC=2) were observed in 1 (0.6%) EVT-treated and 4 (2.2%) MM patients. Symptomatic ICH (sICH) (SITS-MOST definition) was seen in 0.6% EVT patients and 1.2% MM patients. No trend for ICH with core volumes (P=0.10) or Alberta Stroke Program Early CT Score (ASPECTS) (P=0.74) was observed. Among EVT patients, the presence of any ICH did not worsen clinical outcome (modified Rankin Scale (mRS) at 90 days: 4 (3-6) vs 4 (3-6); adjusted generalized OR 1.00, 95% CI 0.68 to 1.47, P>0.99) or modify EVT treatment effect (Pinteraction=0.77). CONCLUSIONS ICH was present in 75% of the EVT population, but PH or sICH were infrequent. The presence of any ICH did not worsen functional outcomes or modify EVT treatment effect at 90-day follow-up. The high rate of hemorrhages overall still represents an opportunity for adjunctive therapies in EVT patients with a large ischemic core.
Collapse
Affiliation(s)
- Michael Chen
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Krishna C Joshi
- Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Bradley Kolb
- Rush University Medical Center, Chicago, Illinois, USA
| | - Clark W Sitton
- Diagnostic & Interventional Imaging, UT Houston, Houston, Texas, USA
| | | | - Michael G Abraham
- Neurology and Radiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Santiago Ortega-Gutierrez
- Neuroloy, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Scott E Kasner
- Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shazam M Hussain
- Cleveland Clinic Stroke Program, Cleveland Clinic, Cleveland Heights, Ohio, USA
| | | | - Spiros Blackburn
- Neurosurgery, University of Texas Medical School at Houston Vivian L Smith Department of Neurosurgery, Houston, Texas, USA
| | | | - Yin C Hu
- Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Nabeel Herial
- Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Juan F Arenillas
- Stroke Unit, Neurology Department, Stroke Unit. Neurology Department. Universitary Hospital, Valladolid (Spain), Valladolid, Spain
| | - Jenny P Tsai
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - William Hicks
- OhioHealth Neurological Physicians, Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Osman Kozak
- Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Abington Memorial Hospital, Abington, Pennsylvania, USA
| | - Bernard Yan
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Dennis Cordato
- Department of Neurology and Neurophysiology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Nathan W Manning
- Institute of Neurosciences, UNSW Prince of Wales Clinical School, Sydney, New South Wales, Australia
- Advanced Endovascular Therapy, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Mark Parsons
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | | | - Amin Aghaebrahim
- Neurological Institute, Lyerley Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Teddy Wu
- Neurology, Christchurch Hospital, Christchurch, Canterbury, New Zealand
| | | | - Chirag D Gandhi
- Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Fawaz Al-Mufti
- Neurology and Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | | | - Joanna Schaafsma
- Medicine - Div. Neurology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jordi Blasco
- Neurointerventional Department C.D.I, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Navdeep Sangha
- Kaiser Permanente Southern California, Los Angeles, California, USA
| | - Steven Warach
- University of Texas at Austin Dell Seton Medical Center, Austin, Texas, USA
| | - Timothy J Kleinig
- Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Hannah Johns
- University of Melbourne, Parkville, Victoria, Australia
| | - Faris Shaker
- Neurology, University of Texas McGovern Medical School, Houston, Texas, USA
| | | | - Abhishek Ray
- Neurological Surgery, University Hospitals, Cleveland, Ohio, USA
| | - Jeffery Sunshine
- Radiology, University Hospitals-Case Medical Center, Cleveland, Ohio, USA
| | - Amanda Opaskar
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Kelsey R Duncan
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Wei Xiong
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | - Edgar A Samaniego
- Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Thanh N Nguyen
- Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Pascal Jabbour
- Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
| | - Maarten G Lansberg
- Department of Neurology, Stanford Stroke Center, Stanford University, Stanford, California, USA
| | - Cathy Sila
- Neurological Institute, University Hospitals- Case Medical Center, Cleveland, Ohio, USA
- Neurology, Case Western Reserve University School of Medicine
| | - Nicholas C Bambakidis
- Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Stephen Davis
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Lawrence Wechsler
- University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Gregory W Albers
- Neurology & Neurological Sciences, Stanford University, Stanford, California, USA
| | - James C Grotta
- Neurology, Memorial Hermann Hospital/UT Houston, Houston, Texas, USA
| | - Marc Ribo
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Spain
- Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Bruce Campbell
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael D Hill
- Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Amrou Sarraj
- Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| |
Collapse
|
2
|
Joshi KC, Kolb B, Khalili BF, Munich SA, Byrne RW. Surgical Strategies in the Treatment of Giant Pituitary Adenomas. Oper Neurosurg (Hagerstown) 2024; 26:4-15. [PMID: 37655871 DOI: 10.1227/ons.0000000000000896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/12/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The management of giant pituitary adenomas (GPAs) is challenging due to associated endocrinopathies and the close proximity of these tumors to critical structures, such as the optic nerves, structures of the cavernous sinus, and hypothalamus. The objective of this review article was to summarize the current management strategies for giant pituitary adenomas, including the role of open and endoscopic surgical approaches and the role of medical and radiation therapy in conjunction with surgery. METHODS We conducted a retrospective review of GPAs operated at our institute between January 2010 and March 2023. Surgical approaches, extent of resection, and associated complications were documented. Furthermore, we conducted a thorough literature review to identify relevant studies published in the past decade, which were incorporated along with insights gained from our institutional case series of GPAs to analyze and integrate both the existing knowledge base and our institution's firsthand experience in the management of GPAs. RESULTS A total of 46 giant pituitary adenomas (GPAs) were operated on, using various surgical approaches. Transsphenoidal approach was used in 25 cases and a staged approach using transsphenoidal and pterional was used in 15 cases. Other approaches included transcortical-transventricular, transcallosal, pterional/orbitozygomatic, and subfrontal approaches. Complications and technical nuances were reported. CONCLUSION The management of giant pituitary adenomas remains complex, often involving several modalities-open or endoscopic resection, radiosurgery, and medical management of both the tumor and associated endocrinopathies. Surgical resections are often challenging procedures that require careful consideration of several factors, including patient characteristics, tumor location, and size, and the experience and skill of the surgical team.
Collapse
Affiliation(s)
- Krishna C Joshi
- Department of Neurosurgery, Rush University Medical Center, Chicago , Illinois , USA
| | - Bradley Kolb
- Department of Neurosurgery, Rush University Medical Center, Chicago , Illinois , USA
| | | | - Stephan A Munich
- Department of Neurosurgery, Rush University Medical Center, Chicago , Illinois , USA
| | - Richard W Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago , Illinois , USA
| |
Collapse
|
3
|
Joshi KC, Khanna R, Beer-Furlan A, McLaughlin E, Chen M, Crowley RW, Munich SA. Femoral access site complications following neurointerventional procedures: economic implications at a single center. J Neurosurg 2023; 139:1078-1082. [PMID: 36905662 DOI: 10.3171/2023.1.jns222171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/25/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Transfemoral access (TFA) has been the traditional route of arterial access for neurointerventional procedures. Femoral access site complications may occur in 2%-6% of patients. Management of these complications often requires additional diagnostic tests or interventions, each of which may increase the cost of care. The economic impact of a femoral access site complication has not yet been described. The objective of this study was to evaluate the economic consequences of femoral access site complications. METHODS The authors conducted a retrospective review of patients undergoing neuroendovascular procedures at their institute and identified those who experienced femoral access site complications. The subset of patients experiencing these complications during elective procedures was matched in a 1:2 fashion to a control group undergoing similar procedures and not experiencing an access site complication. RESULTS Femoral access site complications were identified in 77 patients (4.3%) over a 3-year period. Thirty-four of these complications were considered major, requiring blood transfusion or additional invasive treatment. There was a statistically significant difference in total cost ($39,234.84 vs $23,535.32, p = 0.001), total reimbursement ($35,500.24 vs $24,861.71, p = 0.020) and reimbursement minus cost (-$3734.60 vs $1326.39, p = 0.011) between the complication and control cohorts in elective procedures, respectively. CONCLUSIONS Although occurring relatively infrequently, femoral artery access site complications increase the cost of care for patients undergoing neurointerventional procedures; how this influences the cost effectiveness of neurointerventional procedures warrants further investigation.
Collapse
Affiliation(s)
| | | | - André Beer-Furlan
- 2Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Michael Chen
- Departments of1Neurosurgery and
- 3Radiology, Rush University Medical Center, Chicago, Illinois; and
| | - R Webster Crowley
- Departments of1Neurosurgery and
- 3Radiology, Rush University Medical Center, Chicago, Illinois; and
| | - Stephan A Munich
- Departments of1Neurosurgery and
- 3Radiology, Rush University Medical Center, Chicago, Illinois; and
| |
Collapse
|
4
|
Morrison JD, Joshi KC, Beer Furlan A, Kolb B, Radaideh Y, Munich S, Crowley W, Chen M. Feasibility of robotic neuroendovascular surgery. Interv Neuroradiol 2023:15910199221097898. [PMID: 37543370 DOI: 10.1177/15910199221097898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Several recent reports of CorPath GRX vascular robot (Cordinus Vascular Robotics, Natick, MA) use intracranially suggest feasibility of neuroendovascular application. Further use and development is likely. During this progression it is important to understand endovascular robot feasibility principles established in cardiac and peripheral vascular literature which enabled extension intracranially. Identification and discussion of robotic proof of concept principals from sister disciplines may help guide safe and accountable neuroendovascular application. OBJECTIVE Summarize endovascular robotic feasibility principals established in cardiac and peripheral vascular literature relevant to neuroendovascular application. METHODS Searches of PubMed, Scopus and Google Scholar were conducted under PRISMA guidelines1 using MeSH search terms. Abstracts were uploaded to Covidence citation review (Covidence, Melbourne, AUS) using RIS format. Pertinent articles underwent full text review and findings are presented in narrative and tabular format. RESULTS Search terms generated 1642 articles; 177, 265 and 1200 results for PubMed, Scopus and Google Scholar respectively. With duplicates removed, title review identified 176 abstracts. 55 articles were included, 45 from primary review and 10 identified during literature review. As it pertained to endovascular robotic feasibility proof of concept 12 cardiac, 3 peripheral vascular and 5 neuroendovascular studies were identified. CONCLUSIONS Cardiac and peripheral vascular literature established endovascular robot feasibility and efficacy with equivalent to superior outcomes after short learning curves while reducing radiation exposure >95% for the primary operator. Limitations of cost, lack of haptic integration and coaxial system control continue, but as it stands neuroendovascular robotic implementation is worth continued investigation.
Collapse
Affiliation(s)
- Joseph D Morrison
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Krishna C Joshi
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Andre Beer Furlan
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Bradley Kolb
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Yazan Radaideh
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Stephan Munich
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Webster Crowley
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael Chen
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
5
|
Munich SA, Saganty RS, Joshi KC, Radaideh Y. Evolution of Transradial Access for Mechanical Thrombectomy-A Single Center Experience. Neurosurgery 2023; 92:795-802. [PMID: 36512809 PMCID: PMC9988320 DOI: 10.1227/neu.0000000000002271] [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: 08/02/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Transradial access (TRA) recently has gained popularity among neurointerventionalists. However, hesitation to its use for mechanical thrombectomy (MT) remains. OBJECTIVE To evaluate and describe the evolution of TRA for MT. METHODS We performed a retrospective analysis of patients undergoing TRA for MT. We performed a chronological ternary analysis to assess the impact of experience. We assessed the impact of a guide catheter designed specifically for TRA. RESULTS We identified 53 patients who underwent TRA for MT. There was a statistically significant decrease in contrast use (148.9 vs 109.3 vs 115.2 cc), procedure time (62.4 vs 44.7 vs 41.3 minutes), fluoroscopy time (39.2 vs 44.7 vs 41.3 minutes), and puncture-to-recanalization time (40.6 vs 27.3 vs 29.4) over time. There was trend toward improved thrombolysis in cerebral infarction ≥ 2b recanalization rate (72.2% vs 77.8% vs 100%) over time. The introduction of a radial-specific catheter had a statistically significant positive impact on contrast use (133.8 vs 93 cc, P = .043), procedure time (54.2 vs 36.4 minutes, P = .003), fluoroscopy time (33.7 vs 19.8 minutes, P = .004), puncture-to-recanalization time (35.8 vs 25.1 minutes, P = .016), and thrombolysis in cerebral infarction ≥ 2b recanalization rate (71.4% vs 100%, P = .016). CONCLUSION TRA is a safe and effective route of endovascular access for MT. Experience with this technique improves its efficacy and efficiency. The introduction of a TRA-specific catheter expands the armamentarium of the neurointerventionalist and may facilitate lesion access during MT procedures. Continued development of radial-specific devices may further improve MT outcomes.
Collapse
Affiliation(s)
- Stephan A. Munich
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
- Department of Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Ruth S. Saganty
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Krishna C. Joshi
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Yazan Radaideh
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
6
|
Joshi KC, Khanna R, Richards D, Lopes D. Technical Challenges in Endovascular Treatment of Ruptured Aneurysm in a Patient with Body Mass Index >100. World Neurosurg 2023; 171:148-151. [PMID: 36640833 DOI: 10.1016/j.wneu.2023.01.027] [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: 09/01/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND Morbid obesity can pose unique challenges in the endovascular treatment of cerebrovascular diseases, particularly in the management of ruptured aneurysms. CASE DESCRIPTION This technical report discusses the challenges faced during the treatment of a ruptured aneurysm in a morbidly obese patient with a body mass index of 101. The technical adaptations used included the utilization of Dyna CT for routine imaging, vacuum assist devices for patient transfer, and a transradial approach to avoid groin complications. The technical adaptations used in the management of the ruptured aneurysm in the morbidly obese patient were effective in overcoming the challenges posed by the patient's obesity. CONCLUSION This technical report and literature review can serve as a guide for physicians treating morbidly obese patients with cerebrovascular diseases. Utilization of advanced technology and innovative approaches can aid in overcoming the challenges posed by obesity and improving patient outcomes.
Collapse
Affiliation(s)
- Krishna C Joshi
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
| | - Ryan Khanna
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Dominick Richards
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Demetrius Lopes
- Department of Neurosurgery, Advocate Aurora Health System, Chicago, Illinois, USA
| |
Collapse
|
7
|
Woodward J, Meza S, Richards D, Koro L, Keegan KC, Joshi KC, Munoz LF, Byrne RW, John S. The Scope and Impact of the COVID-19 Pandemic on Neuroemergent Patient Transfers, Clinical Care and Patient Outcomes. Front Surg 2022; 9:914798. [PMID: 35756465 PMCID: PMC9218208 DOI: 10.3389/fsurg.2022.914798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/19/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction The SARS-CoV-2 (COVID-19) pandemic continues to substantially alter previously established clinical practice patterns and has transformed patient care in American healthcare. However, studies to evaluate the impact of COVID-19 on neuroemergent patient care and associated clinical outcomes are limited. Herein, we describe the impact of COVID-19 on the Neuroemergency Transfer Program (NTP) - a novel, urban, high volume interhospital patient transfer program. Objective To evaluate and describe the clinical impact of the COVID-19 pandemic on the NTP. Study Design A single-center retrospective study of prospectively collected consecutive neuroemergent patient transfer data between 2018–2021 was analyzed. Adult patients were divided based upon transfer date into a Pre-COVID (PCOV) or COVID cohort. Patient demographics, transfer characteristics and clinical data and outcomes were analyzed. Results 3,096 patients were included for analysis. Mean age at transfer in the PCOV and COVID cohorts were 62.4 ± 0.36 and 61.1 ± 0.6 years. A significant decrease in mean transfers per month was observed between cohorts (PCOV = 97.8 vs. COV = 68.2 transfers/month, p < 0.01). Total transfer time in the PCOV cohort was 155.1 ± 3.4 min which increased to 169.3 ± 12.8 min in the COVID cohort (p = 0.13). Overall mean transfer distance was significantly longer in the PCOV cohort at 22.0 ± 0.4 miles vs. 20.3 ± 0.67 miles in the COV cohort (p = 0.03). The relative frequency of transfer diagnoses was unchanged between cohorts. A significant increase in mean inpatient length of stay was noted, 7.9 ± 0.15 days to 9.6 ± 0.33 days in the PCOV vs. COVID cohorts (p < 0.01). Ultimately, no difference in the frequency of good vs. poor clinical outcome were noted between the PCOV (79.8% and 19.4%) vs. COV (78.8% and 20.4%) cohorts. Conclusion The impact of COVID-19 on current healthcare dynamics are far reaching. Here, we show a significant decrease in interhospital patient transfers and increased length of stay between a Pre-COVID and COVID cohort. Further work to better elucidate the specific interplay of clinical contributors to account for these changes is indicated.
Collapse
Affiliation(s)
- Josha Woodward
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Samuel Meza
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Dominick Richards
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Lacin Koro
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Kevin C. Keegan
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Krishna C. Joshi
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Lorenzo F. Munoz
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Richard W. Byrne
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Sayona John
- Department of Neurology, Rush University Medical Center, Chicago, IL, United States
- Correspondence: Sayona John
| |
Collapse
|
8
|
Joshi KC, Grewal P, Beer-Furlan A, Vargas A, Osteraas N, Dafer R, Chen M. Endovascular thrombectomy for acute ischemic stroke in patients with cancer: a propensity-matched analysis. J Neurointerv Surg 2021; 14:1161-1165. [PMID: 34880077 DOI: 10.1136/neurintsurg-2021-018211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/10/2021] [Accepted: 11/23/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND There is a paucity of data and a belief that endovascular thrombectomy (EVT) has low efficacy for acute ischemic stroke (AIS) in patients with cancer. We aimed to critically compare the clinical outcomes of EVT for AIS in patients with and without cancer. METHODS Records of all patients undergoing EVT for AIS between January 2015 and 2020 were screened for cancer at the time of EVT. Active cancer was defined as patients who were diagnosed with cancer and were undergoing or refused treatment for that cancer. Baseline modified Rankin Scale (mRS), age and sex were used in a 1:5 propensity score matching ratio. After matching we evaluated for any change in the National Institutes of Health Stroke Scale (NIHSS) from baseline to discharge, hemorrhagic transformation (HT), and 90-day mRS and mortality. RESULTS There were 19 patients with cancer and 95 matched controls. The mean±SD age was 70.89±11.16 years, and 17 (89.47%) were female. The baseline NIHSS was 22±7.5 and baseline mRS was 1 (IQR 1). There was no significant difference in change in baseline to discharge NIHSS, 90-day mRS or mortality; 90-day mRS 0-2 was 45.2% in the non-cancer group versus 46.7% in cancer group (p=0.54). HT was significantly higher in patients with cancer (57.89% vs 6.49%, p<0.001). CONCLUSIONS In propensity matched analysis of patients undergoing EVT for AIS with and without cancer, 90-day functional outcomes and mortality were similar. However, there was a significantly higher rate of HT in cancer patients.
Collapse
Affiliation(s)
- Krishna C Joshi
- Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Parneet Grewal
- Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - André Beer-Furlan
- Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Alejandro Vargas
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Nicholas Osteraas
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Rima Dafer
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Chen
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
9
|
Mehta GU, Lekovic GP, Slattery WH, Brackmann DE, Long H, Kano H, Kondziolka D, Mureb M, Bernstein K, Langlois AM, Mathieu D, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Mohammed N, Urgosik D, Liscak R, Lee CC, Yang HC, Montazeripouragha A, Kaufmann AM, Joshi KC, Barnett GH, Trifiletti DM, Lunsford LD, Sheehan JP. Effect of Anatomic Segment Involvement on Stereotactic Radiosurgery for Facial Nerve Schwannomas: An International Multicenter Cohort Study. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa313_s078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
10
|
Renieri L, Valente I, Dmytriw AA, Puri AS, Singh J, Nappini S, Nencini P, Kaliaev A, Abdalkader M, Alexandre A, Garignano G, Vivekanandan S, Fong RP, Parra-Fariñas C, Spears J, Gomez-Paz S, Ogilvy C, Regenhardt RW, Alotaibi N, Beer-Furlan A, Joshi KC, Walker M, Vicenty-Padilla J, Darcourt J, Foreman P, Kuhn AL, Nguyen TN, Griessenauer CJ, Marotta TR, Thomas A, Patel AB, Leslie-Mazwi TM, Chen M, Levitt MR, Chen K, Cognard C, Pedicelli A, Limbucci N. Mechanical thrombectomy beyond the circle of Willis: efficacy and safety of different techniques for M2 occlusions. J Neurointerv Surg 2021; 14:546-550. [PMID: 34226193 DOI: 10.1136/neurintsurg-2021-017425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/16/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND M2 segment occlusions represent approximately one-third of non-lacunar ischemic stroke and can lead to permanent neurological deficits. Various techniques are available for mechanical thrombectomy beyond the circle of Willis, but data evaluating their effectiveness and safety are lacking. METHODS A retrospective review of patients with ischemic stroke undergoing mechanical thrombectomy for M2 occlusions from 13 centers in North American and Europe was performed. Tandem or multiple-territory occlusions were excluded. The primary outcome was 90-day modified Rankin Scale and reperfusion rates across stent-retriever, direct aspiration and combined techniques. RESULTS There were 465 patients (mean age 71.48±14.03 years, 53.1% female) with M2 occlusions who underwent mechanical thrombectomy. Stent-retriever alone was used in 133 (28.6%), direct aspiration alone in 93 (20.0%) and the combined technique in 239 (51.4%) patients. Successful reperfusion was achieved with the combined technique in 198 (82.2%; OR 2.6 (1.1-6.9)), with stent-retriever alone in 112 (84.2%; OR 9.2 (1.9-44.6)) and with direct aspiration alone in 62 (66.7%; referencecategory). Intraprocedural subarachnoid hemorrhages (iSAH) were 36 (7.7%) and were more likely to occur in patients treated with the stent-retrievers (OR 5.0 (1.1-24.3)) and combined technique (OR 4.6 (1.1-20.9)). Good clinical outcome was achieved in 260 (61.8%) patients, while 59 (14.0%) patients died. Older age, higher baseline NIHSS (National Institutes of Health Stroke Scale), parenchymal hemorrhage and iSAH were associated with poor outcome while successful recanalization and higher baseline ASPECTS (Alberta Stroke Program Early CT Score) were associated with good outcome. No differences were found among the three techniques in terms of clinical outcome. CONCLUSION Stent-retrievers and a combined approach for M2 occlusions seem more effective than direct aspiration, but with higher rates of iSAH. This leads to no detectable difference in clinical outcome at 3 months.
Collapse
Affiliation(s)
- Leonardo Renieri
- Interventional Neuroravascular Unit, University Hospital Careggi, Firenze, Italy
| | - Iacopo Valente
- UOC Radiologia e Neuroradiologia, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Adam A Dmytriw
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ajit S Puri
- Division of Neuroradiology, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jasmeet Singh
- Division of Neuroradiology, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sergio Nappini
- Neurovascular Interventional Unit, University Hospital Careggi, Firenze, Italy
| | | | - Artem Kaliaev
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Andrea Alexandre
- UOC Radiologia e Neuroradiologia, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Giuseppe Garignano
- UOC Radiologia e Neuroradiologia, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Sheela Vivekanandan
- Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Reginald P Fong
- Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Carmen Parra-Fariñas
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Julian Spears
- Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Santiago Gomez-Paz
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Christopher Ogilvy
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Naif Alotaibi
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - André Beer-Furlan
- Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Krishna C Joshi
- Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Melanie Walker
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Juan Vicenty-Padilla
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jean Darcourt
- Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
| | - Paul Foreman
- Department of Neurosurgery, Orlando Health Corp, Orlando, Florida, USA
| | - Anna L Kuhn
- Division of Neuroradiology, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
| | | | - Thomas R Marotta
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ajith Thomas
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Michael Chen
- Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Karen Chen
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christophe Cognard
- Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
| | - Alessandro Pedicelli
- UOC Radiologia e Neuroradiologia, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Nicola Limbucci
- Interventional Neuroravascular Unit, University Hospital Careggi, Firenze, Italy
| |
Collapse
|
11
|
Kaginele P, Beer-Furlan A, Joshi KC, Kadam G, Achanaril A, Levy E, Waqas M, Siddiqui A, Rai H, Snyder K, Davies J, Crowley RW, Ouyang B, Munich S, Chen M. Brain Atrophy and Leukoaraiosis Correlate with Futile Stroke Thrombectomy. J Stroke Cerebrovasc Dis 2021; 30:105871. [PMID: 34102555 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105871] [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: 02/12/2021] [Revised: 04/22/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Although mechanical thrombectomy (MT) is a proven therapy for acute large vessel occlusion strokes, futile recanalization in the elderly is common and costly. Strategies to minimize futile recanalization may reduce unnecessary thrombectomy transfers and procedures. We evaluated whether a simple and rapid visual assessment of brain atrophy and leukoaraiosis on a plain head CT correlates with futile stroke recanalization in the elderly. METHODS Consecutive stroke patients admitted for thrombectomy, older than 65 years of age, all with TICI 2b/3 recanalization rates were retrospectively studied from multiple comprehensive stroke centers. Brain atrophy and leukoaraiosis were visually analyzed from pre-intervention plain head CTs using a simplified scheme based on validated scales. Baseline demographics were collected and the primary outcome measure was 90-day modified Rankin score (mRS). Cochran-Armitage trend test was applied in analyzing the association of the severity of brain atrophy and leukoaraiosis with 90-day mRS. RESULTS Between 2017 and 2019, 175 patients > 65 years who underwent thrombectomy with TICI 2b/3 recanalization from two comprehensive stroke centers were evaluated. The median age was 77 years. IV-tPA was given in 59% of patients, average initial NIHSS was 19, average baseline mRS was 0.77 and median time to recanalization was 300 minutes. Age and severity of atrophy/leukoaraiosis was categorized into three groups of increasing severity and associated with 90 day mRS 0-3 rates of 62%, 49% and 41% (p=0.037) respectively. CONCLUSIONS A simplified, visual assessment of the degree of brain atrophy and leukoaraiosis measured on plain head CT correlates with futile recanalization in patients age >65 years. Although additional validation is needed, these findings suggest that brain atrophy and leukoaraiosis may have value as a surrogate marker of prestroke functional status. In doing so, simplified visual plain head CT grading scales may minimize elderly futile recanalization.
Collapse
Affiliation(s)
| | - Andre Beer-Furlan
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Krishna C Joshi
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Geetanjalee Kadam
- Department of Radiology, Rush University Medical Center, Chicago, Illinois, United States
| | - Anoop Achanaril
- Department of Radiology, Rush University Medical Center, Chicago, Illinois, United States
| | - Elad Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, United States
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, United States
| | - Adnan Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, United States
| | - Hamid Rai
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, United States
| | - Kenneth Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, United States
| | - Jason Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, United States
| | - R Webster Crowley
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Bichun Ouyang
- Rush Medical College, Chicago, Illinois, United States
| | - Stephan Munich
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Michael Chen
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, United States.
| |
Collapse
|
12
|
Mehta GU, Lekovic GP, Slattery WH, Brackmann DE, Long H, Kano H, Kondziolka D, Mureb M, Bernstein K, Langlois AM, Mathieu D, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Mohammed N, Urgosik D, Liscak R, Lee CC, Yang HC, Montazeripouragha A, Kaufmann AM, Joshi KC, Barnett GH, Trifiletti DM, Lunsford LD, Sheehan JP. Effect of Anatomic Segment Involvement on Stereotactic Radiosurgery for Facial Nerve Schwannomas: An International Multicenter Cohort Study. Neurosurgery 2021; 88:E91-E98. [PMID: 32687577 DOI: 10.1093/neuros/nyaa313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/13/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Facial nerve schwannomas are rare, challenging tumors to manage due to their nerve of origin. Functional outcomes after stereotactic radiosurgery (SRS) are incompletely defined. OBJECTIVE To analyze the effect of facial nerve segment involvement on functional outcome for these tumors. METHODS Patients who underwent single-session SRS for facial nerve schwannomas with at least 3 mo follow-up at 11 participating centers were included. Preoperative and treatment variables were recorded. Outcome measures included radiological tumor response and neurological function. RESULTS A total of 63 patients (34 females) were included in the present study. In total, 75% had preoperative facial weakness. Mean tumor volume and margin dose were 2.0 ± 2.4 cm3 and 12.2 ± 0.54 Gy, respectively. Mean radiological follow-up was 45.5 ± 38.9 mo. Progression-free survival at 2, 5, and 10 yr was 98.1%, 87.2%, and 87.2%, respectively. The cumulative proportion of patients with regressing tumors at 2, 5, and 10 yr was 43.1%, 63.6%, and 63.6%, respectively. The number of involved facial nerve segments significantly predicted tumor progression (P = .04). Facial nerve function was stable or improved in 57 patients (90%). Patients with involvement of the labyrinthine segment of the facial nerve were significantly more likely to have an improvement in facial nerve function after SRS (P = .03). Hearing worsened in at least 6% of patients. Otherwise, adverse radiation effects included facial twitching (3 patients), facial numbness (2 patients), and dizziness (2 patients). CONCLUSION SRS for facial nerve schwannomas is effective and spares facial nerve function in most patients. Some patients may have functional improvement after treatment, particularly if the labyrinthine segment is involved.
Collapse
Affiliation(s)
- Gautam U Mehta
- Division of Neurosurgery, House Ear Institute, Los Angeles, California
| | - Gregory P Lekovic
- Division of Neurosurgery, House Ear Institute, Los Angeles, California
| | | | | | - Hao Long
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hideyuki Kano
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Monica Mureb
- Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Kenneth Bernstein
- Department of Radiation Oncology, NYU Langone Medical Center, New York, New York
| | - Anne-Marie Langlois
- Department of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nasser Mohammed
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Dusan Urgosik
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | | | - Krishna C Joshi
- Department of Neuro-oncology, Cleveland Clinic, Cleveland, Ohio
| | - Gene H Barnett
- Department of Neuro-oncology, Cleveland Clinic, Cleveland, Ohio
| | | | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| |
Collapse
|
13
|
Joshi KC, Beer-Furlan A, Crowley RW, Munich SA. Pre-operative embolization followed by clipping of Cognard type V dural arteriovenous fistula. J Neurointerv Surg 2021:neurintsurg-2020-017201. [PMID: 33766939 DOI: 10.1136/neurintsurg-2020-017201] [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: 12/15/2020] [Revised: 02/06/2021] [Accepted: 02/13/2021] [Indexed: 11/03/2022]
Abstract
This article has been retracted because it describes the use of an investigative agent that has not been approved by the Food and Drug Administration.
Collapse
Affiliation(s)
- Krishna C Joshi
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - André Beer-Furlan
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - R Webster Crowley
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Stephan A Munich
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
14
|
Alawieh A, Al Kasab S, Almallouhi E, Levitt MR, Jabbour PM, Sweid A, Starke RM, Saini V, Fargen KM, Wolfe SQ, Arthur AS, Goyal N, Fragata I, Maier I, Matouk C, Howard BM, Grossberg JA, Cawley M, Kan P, Hafeez M, Singer J, Crowley RW, Joshi KC, Brinjikji W, Savastano LE, Ogilvy CS, Gomez-Paz S, Levy E, Waqas M, Mokin M, Veznedaroglu E, Binning M, Mascitelli J, Yoo AJ, Soomro J, Williamson RW, Chalhoub RM, Grande A, Crosa R, Webb S, Psychogios M, Ducruet AF, Albuquerque FC, Majmundar N, Turner R, Casagrande W, Al-Mufti F, De Leacy R, Mocco J, Fessler RD, Osanai T, Chowdhry SA, Park M, Schirmer CM, Ringer A, Spiotta AM. Letter: An International Investigation Into the COVID-19 Pandemic and Workforce Depletion in Highly Specialized Neurointerventional Units - Insights From Stroke Thrombectomy and Aneurysm Registry and Endovascular Neurosurgery Research Group. Neurosurgery 2020; 87:E697-E699. [PMID: 32893855 PMCID: PMC7499731 DOI: 10.1093/neuros/nyaa415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 01/26/2023] Open
Affiliation(s)
- Ali Alawieh
- Department of Neurosurgery Emory University School of Medicine Atlanta, Georgia
| | - Sami Al Kasab
- Department of Neurosurgery Medical University of South Carolina Charleston, South Carolina.,Department of Neurology Medical University of South Carolina Charleston, South Carolina
| | - Eyad Almallouhi
- Department of Neurology Medical University of South Carolina Charleston, South Carolina
| | - Michael R Levitt
- Department of Neurosurgery University of Washington Seattle, Washington
| | - Pascal M Jabbour
- Department of Neurosurgery Thomas Jefferson University Hospitals Philadelphia, Pennsylvania
| | - Ahmad Sweid
- Department of Neurosurgery Thomas Jefferson University Hospitals Philadelphia, Pennsylvania
| | - Robert M Starke
- Department of Neurosurgery University of Miami Health System Miami, Florida
| | - Vasu Saini
- Department of Neurosurgery University of Miami Health System Miami, Florida
| | - Kyle M Fargen
- Department of Neurosurgery Wake Forest School of Medicine Winston Salem, North Carolina
| | - Stacey Q Wolfe
- Department of Neurosurgery Wake Forest School of Medicine Winston Salem, North Carolina
| | - Adam S Arthur
- Department of Neurosurgery Semmes-Murphey Neurologic and Spine Clinic University of Tennessee Health Science Center Memphis, Tennessee
| | - Nitin Goyal
- Department of Neurosurgery Semmes-Murphey Neurologic and Spine Clinic University of Tennessee Health Science Center Memphis, Tennessee.,Department of Neurology University of Tennessee Health Science Center Memphis, Tennessee
| | - Isabel Fragata
- Neuroradiology Department Hospital São José Centro Hospitalar Lisboa Central Lisboa, Portugal
| | - Ilko Maier
- Department of Neurology University Medical Center Göttingen Göttingen, Germany
| | - Charles Matouk
- Department of Neurosurgery Yale University/Yale-New Haven Hospital New Haven, Connecticut
| | - Brian M Howard
- Department of Neurosurgery Emory University School of Medicine Atlanta, Georgia
| | | | - Michael Cawley
- Department of Neurosurgery Emory University School of Medicine Atlanta, Georgia
| | - Peter Kan
- Department of Neurosurgery Baylor School of Medicine Houston, Texas
| | - Muhammad Hafeez
- Department of Neurosurgery Baylor School of Medicine Houston, Texas
| | - Justin Singer
- Division of Neurosurgery Spectrum Health Grand Rapids, Michigan
| | | | - Krishna C Joshi
- Department of Neurosurgery Rush University Chicago, Illinois
| | | | | | | | - Santiago Gomez-Paz
- Department of Neurosurgery Beth Israel Deaconess Hospital Boston, Massachusetts
| | - Elad Levy
- Department of Neurosurgery University at Buffalo Buffalo, New York
| | - Muhammad Waqas
- Department of Neurosurgery University at Buffalo Buffalo, New York
| | - Maxim Mokin
- Department of Neurosurgery University of South Florida Tampa, Florida
| | | | - Mandy Binning
- Global Neurosciences Institute Pennington, New Jersey
| | - Justin Mascitelli
- Department of Neurosurgery University of Texas Health Science Center at San Antonio San Antonio, Texas
| | | | | | | | - Reda M Chalhoub
- Department of Neurosurgery Medical University of South Carolina Charleston, South Carolina
| | - Andrew Grande
- Department of Neurosurgery University of Minnesota Minneapolis, Minnesota
| | - Roberto Crosa
- Department of Neurosurgery Centro Endovascular Neurologico Medica Uruguaya Montevideo, Uruguay
| | - Sharon Webb
- Department of Neurosurgery Bon Secours Greenville, South Carolina
| | | | - Andrew F Ducruet
- Department of Neurosurgery Barrow Neurological Institute Phoenix, Arizona
| | | | - Neil Majmundar
- Department of Neurosurgery Barrow Neurological Institute Phoenix, Arizona
| | | | - Walter Casagrande
- Department of Cerebrovascular and Endovascular Neurosurgery Hospital Juan Fernandez Buenos Aires, Argentina
| | - Fawaz Al-Mufti
- Department of Neurosurgery and Radiology Westchester Medical Center New York, New York
| | - Reade De Leacy
- Department of Neurosurgery Mount Sinai Health System New York, New York
| | - J Mocco
- Department of Neurosurgery Mount Sinai Health System New York, New York
| | | | | | - Shakeel A Chowdhry
- Department of Neurosurgery NorthShore University Health System Evanston, Illinois
| | - Min Park
- Department of Neurosurgery University of Virginia Charlottesville, Virginia
| | - Clemens M Schirmer
- Department of Neurosurgery and Neuroscience Institute Geisinger Health System Wilkes-Barre, Pennsylvania.,Research Institute of Neurointervention Paracelsus Medical University Salzburg, Austria
| | - Andrew Ringer
- Department of Neurosurgery Mayfield Brain & Spine Cincinnati, Ohio
| | - Alejandro M Spiotta
- Department of Neurosurgery Medical University of South Carolina Charleston, South Carolina
| | | |
Collapse
|
15
|
Joshi KC, Raghavan A, Muhsen B, Hsieh J, Borghei-Razavi H, Chao ST, Barnett GH, Suh JH, Neyman G, Kshettry VR, Recinos PF, Mohammadi AM, Angelov L. Fractionated Gamma Knife radiosurgery for skull base meningiomas: a single-institution experience. Neurosurg Focus 2020; 46:E8. [PMID: 31153152 DOI: 10.3171/2019.3.focus1963] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEGamma Knife radiosurgery (GKRS) has been successfully used for the treatment of intracranial meningiomas given its steep dose gradients and high-dose conformality. However, treatment of skull base meningiomas (SBMs) may pose significant risk to adjacent radiation-sensitive structures such as the cranial nerves. Fractionated GKRS (fGKRS) may decrease this risk, but until recently it has not been practical with traditional pin-based systems. This study reports the authors' experience in treating SBMs with fGKRS, using a relocatable, noninvasive immobilization system.METHODSThe authors performed a retrospective review of all patients who underwent fGKRS for SBMs between 2013 and 2018 delivered using the Extend relocatable frame system or the Icon system. Patient demographics, pre- and post-GKRS tumor characteristics, perilesional edema, prior treatment details, and clinical symptoms were evaluated. Volumetric analysis of pre-GKRS, post-GKRS, and subsequent follow-up visits was performed.RESULTSTwenty-five patients met inclusion criteria. Nineteen patients were treated with the Icon system, and 6 patients were treated with the Extend system. The mean pre-fGKRS tumor volume was 7.62 cm3 (range 4.57-13.07 cm3). The median margin dose was 25 Gy delivered in 4 (8%) or 5 (92%) fractions. The median follow-up time was 12.4 months (range 4.7-17.4 months). Two patients (9%) experienced new-onset cranial neuropathy at the first follow-up. The mean postoperative tumor volume reduction was 15.9% with 6 patients (27%) experiencing improvement of cranial neuropathy at the first follow-up. Median first follow-up scans were obtained at 3.4 months (range 2.8-4.3 months). Three patients (12%) developed asymptomatic, mild perilesional edema by the first follow-up, which remained stable subsequently.CONCLUSIONSfGKRS with relocatable, noninvasive immobilization systems is well tolerated in patients with SBMs and demonstrated satisfactory tumor control as well as limited radiation toxicity. Future prospective studies with long-term follow-up and comparison to single-session GKRS or fractionated stereotactic radiotherapy are necessary to validate these findings and determine the efficacy of this approach in the management of SBMs.
Collapse
Affiliation(s)
- Krishna C Joshi
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | | | - Baha'eddin Muhsen
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Jason Hsieh
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
| | - Hamid Borghei-Razavi
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Samuel T Chao
- 3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and.,4Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gene H Barnett
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - John H Suh
- 3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and.,4Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gennady Neyman
- 3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and.,4Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Varun R Kshettry
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Pablo F Recinos
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Alireza M Mohammadi
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Lilyana Angelov
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| |
Collapse
|
16
|
Al Kasab S, Almallouhi E, Alawieh A, Levitt MR, Jabbour P, Sweid A, Starke RM, Saini V, Wolfe SQ, Fargen KM, Arthur AS, Goyal N, Pandhi A, Fragata I, Maier I, Matouk C, Grossberg JA, Howard BM, Kan P, Hafeez M, Schirmer CM, Crowley RW, Joshi KC, Tjoumakaris SI, Chowdry S, Ares W, Ogilvy C, Gomez-Paz S, Rai AT, Mokin M, Guerrero W, Park MS, Mascitelli JR, Yoo A, Williamson R, Grande AW, Crosa RJ, Webb S, Psychogios MN, Ducruet AF, Holmstedt CA, Ringer AJ, Spiotta AM. International experience of mechanical thrombectomy during the COVID-19 pandemic: insights from STAR and ENRG. J Neurointerv Surg 2020; 12:1039-1044. [PMID: 32843359 PMCID: PMC7453763 DOI: 10.1136/neurintsurg-2020-016671] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND In response to the COVID-19 pandemic, many centers altered stroke triage protocols for the protection of their providers. However, the effect of workflow changes on stroke patients receiving mechanical thrombectomy (MT) has not been systematically studied. METHODS A prospective international study was launched at the initiation of the COVID-19 pandemic. All included centers participated in the Stroke Thrombectomy and Aneurysm Registry (STAR) and Endovascular Neurosurgery Research Group (ENRG). Data was collected during the peak months of the COVID-19 surge at each site. Collected data included patient and disease characteristics. A generalized linear model with logit link function was used to estimate the effect of general anesthesia (GA) on in-hospital mortality and discharge outcome controlling for confounders. RESULTS 458 patients and 28 centers were included from North America, South America, and Europe. Five centers were in high-COVID burden counties (HCC) in which 9/104 (8.7%) of patients were positive for COVID-19 compared with 4/354 (1.1%) in low-COVID burden counties (LCC) (P<0.001). 241 patients underwent pre-procedure GA. Compared with patients treated awake, GA patients had longer door to reperfusion time (138 vs 100 min, P=<0.001). On multivariate analysis, GA was associated with higher probability of in-hospital mortality (RR 1.871, P=0.029) and lower probability of functional independence at discharge (RR 0.53, P=0.015). CONCLUSION We observed a low rate of COVID-19 infection among stroke patients undergoing MT in LCC. Overall, more than half of the patients underwent intubation prior to MT, leading to prolonged door to reperfusion time, higher in-hospital mortality, and lower likelihood of functional independence at discharge.
Collapse
Affiliation(s)
- Sami Al Kasab
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.,Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Eyad Almallouhi
- Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ali Alawieh
- Neurosurgery, Emory University, Atlanta, Georgia, USA.,Microbiology and Immunology, Medical University of South Carolina, South Carolina, USA
| | - Michael R Levitt
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Pascal Jabbour
- Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ahmad Sweid
- Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert M Starke
- Neurological Surgery, University of Miami Miller School of Medicine, Miami Beach, Florida, USA.,University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vasu Saini
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stacey Q Wolfe
- Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Kyle M Fargen
- Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Adam S Arthur
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.,Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nitin Goyal
- Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Abhi Pandhi
- Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Isabel Fragata
- Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Ilko Maier
- Neurology, University Medicine Goettingen, Goettingen, NS, Germany
| | - Charles Matouk
- Neurosurgery, Yale University, New Haven, Connecticut, USA
| | - Jonathan A Grossberg
- Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brian M Howard
- Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.,Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Muhammad Hafeez
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | | | | | - Krishna C Joshi
- Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Shakeel Chowdry
- North Shore University Health System, Evanston, Illinois, USA
| | - William Ares
- Neurosurgery, North Shore University Health System, Evanston, Illinois, USA
| | | | | | - Ansaar T Rai
- Department of Neurointerventional Radiology, West Virginia University, Morgantown, West Virginia, USA
| | - Maxim Mokin
- Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Waldo Guerrero
- Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Min S Park
- Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Justin R Mascitelli
- Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Albert Yoo
- Texas Stroke Institute, Fort Worth, Texas, USA
| | - Richard Williamson
- Stroke & Cerebrovascular Center, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Andrew Walker Grande
- Neurosurgery, Radiology and Neurology, University of Minnesota, Mendota Heights, Minnesota, USA
| | | | - Sharon Webb
- Neurosurgery, Bon Secours St Francis Hospital, Greenville, South Carolina, USA
| | - Marios N Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | - Andrew J Ringer
- Neurosurgery, Mayfield Clinic, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alejandro M Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | | |
Collapse
|
17
|
Kerolus MG, Joshi KC, Johnson AK, Beer-Furlan A, Mangubat EZ, Theessen H, Schafer S, Lopes DK. Co-registration of Intravascular Ultrasound With Angiographic Imaging for Carotid Artery Disease. World Neurosurg 2020; 143:325-331. [PMID: 32777396 DOI: 10.1016/j.wneu.2020.07.226] [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: 04/24/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intravascular ultrasound (IVUS) provides endoluminal views and cross-sectional images of carotid arteries but lacks overview of vascular territory provided by angiography. Co-registration of IVUS with angiographic images may provide the potential to navigate both imaging modalities in a synchronous manner. The objective of this study is to evaluate the feasibility and accuracy of co-registering both imaging modalities in the carotid vasculature of the neck. METHODS Fourteen patients with 15 cervical carotid artery lesions underwent angiography and subsequent treatment. In each case, an IVUS catheter was advanced to the target lesion and a reference angiography sequence was acquired. This was followed by an electrocardiography-triggered fluoroscopy sequence that was initiated upon IVUS catheter pullback. IVUS data collected during pullback were registered with fluoroscopy and evaluated for error and clinical usability. RESULTS A total of 32 landmarks were identified that demonstrated reasonable agreement during IVUS-angiography co-registration. There was a mean registration error distance of 3.36 mm (SD 2.82 mm) between targets. The longitudinal extent and severity of the disease through the target segment could be easily evaluated after co-registration. CONCLUSION Semiautomatic tracking and co-registration of angiography and IVUS is a new technology and has the potential to increase the use of IVUS in carotid disease and to proivde the opportunity to optimize procedural outcomes.
Collapse
Affiliation(s)
- Mena G Kerolus
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Krishna C Joshi
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Andrew K Johnson
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - André Beer-Furlan
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Erwin Z Mangubat
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Heike Theessen
- Siemens Healthcare, Imaging and Therapy Systems, Forchheim, Germany
| | | | - Demetrius K Lopes
- Department of Neurosurgery, Advocate Aurora Health System, Chicago, Illinois, USA.
| |
Collapse
|
18
|
Beer-Furlan A, Joshi KC, Brahimaj B, Lopes DK. Transvenous Onyx Embolization of Carotid-Cavernous Fistulas: Mid- and Long-Term Outcomes. J Neurol Surg B Skull Base 2020; 82:e278-e284. [PMID: 34306950 DOI: 10.1055/s-0040-1710514] [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: 09/07/2019] [Accepted: 03/19/2020] [Indexed: 10/24/2022] Open
Abstract
Objective Endovascular treatment of carotid-cavernous fistulas (CCFs) has been consistently shown to give excellent results and is currently the mainstay of treatment of these complex vascular pathologies. Onyx is currently the most widely used agent, but there has been concern over high rates of cranial nerve (CN) deficits seen in patients with CCF treated with Onyx and paucity of data on long-term outcomes. Methods This is a retrospective analysis of patients who underwent transvenous Onyx embolization between 2011 and 2018. The data collected included demographics, comorbidities, presenting symptoms, CCF morphology, degree of obliteration, procedure-related complications, clinical outcomes, and follow-up. Results A total of seven patients (five females) were included. The median age was 66 years (range: 15-79 years). Median duration of symptoms before treatment was 4 weeks (range: 1-24 weeks). There were three direct and four indirect CCFs. Barrow classification is as follows: A-3; B-3; C-0; and D-1. Immediate complete occlusion was achieved in all cases. There was also one case of immediate postoperative change in CN function (new partial CN VI deficit) that resolved completely at 1-month follow-up. The mean length of stay was 3 days (±2). The preoperative extraocular movement CN deficits had the following outcomes: three resolved; two improved; and one persisted. Proptosis, chemosis, conjunctival injection, and tinnitus were resolved in all patients. The median follow-up was 34 months (range: 10-91 months). Conclusion Transvenous Onyx embolization is a safe and effective treatment of CCFs when technical aspects to reduce complications are performed diligently. Our technique demonstrates safety of the Onyx as a stand-alone embolization for the treatment of CCF.
Collapse
Affiliation(s)
- André Beer-Furlan
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Krishna C Joshi
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Bledi Brahimaj
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Demetrius K Lopes
- Advocate Aurora Health, Cerebrovascular Neurosurgery and Comprehensive Stroke Center, Chicago, Illinois, United States
| |
Collapse
|
19
|
Shao J, Radakovich NR, Grabowski M, Borghei-Razavi H, Knusel K, Joshi KC, Muhsen BA, Hwang L, Barnett GH, Mohammadi AM. Lessons Learned in Using Laser Interstitial Thermal Therapy for Treatment of Brain Tumors: A Case Series of 238 Patients from a Single Institution. World Neurosurg 2020; 139:e345-e354. [PMID: 32298824 DOI: 10.1016/j.wneu.2020.03.213] [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: 12/10/2019] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) is a novel, minimally invasive alternative to craniotomy, and as with any new technology, comes with a learning curve. OBJECTIVE We present our experience detailing the evolution of this technology in our practice in one of the largest patient cohorts to date regarding LITT in neuro-oncology. METHODS We reviewed 238 consecutive patients with brain tumor treated with LITT at our institution. Data on patient, surgery and tumor characteristics, and follow-up were collected. Patients were categorized into 2 cohorts: early (<2014, 100 patients) and recent (>2015, 138 patients). Median follow-up for the entire cohort was 8.4 months. RESULTS The indications for LITT included gliomas (70.2%), radiation necrosis (21.0%), and metastasis (8.8%). Patient demographics stayed consistent between the 2 cohorts, with the exception of age (early, 54.3; recent, 58.4; P = 0.04). Operative time (6.6 vs. 3.5; P < 0.001) and number of trajectories (53.1% vs. 77.9% with 1 trajectory; P < 0.001) also decreased in the recent cohort. There was a significant decrease in permanent motor deficits over time (15.5 vs. 4.4%; P = 0.005) and 30-day mortality (4.1% vs. 1.5%) also decreased (not statistically significant) in the recent cohort. In terms of clinical outcomes, poor preoperative Karnofsky Performance Status (≤70) were significantly correlated with increased permanent deficits (P = 0.001) and decreased overall survival (P < 0.001 for all time points). CONCLUSIONS We observed improvement in operative efficiency and permanent deficits over time and also patients with poor preoperative Karnofsky Performance Status achieved suboptimal outcomes with LITT. As many other treatment modalities, patient selection is important in this procedure.
Collapse
Affiliation(s)
- Jianning Shao
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA; Case Western School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nathan R Radakovich
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA; Case Western School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Matthew Grabowski
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hamid Borghei-Razavi
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Konrad Knusel
- Case Western School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Krishna C Joshi
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Baha'eddin A Muhsen
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lee Hwang
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gene H Barnett
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alireza M Mohammadi
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA.
| |
Collapse
|
20
|
Joshi KC, Beer-Furlan A, Crowley RW, Chen M, Munich SA. Transradial approach for neurointerventions: a systematic review of the literature. J Neurointerv Surg 2020; 12:886-892. [PMID: 32152185 PMCID: PMC7476364 DOI: 10.1136/neurintsurg-2019-015764] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [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: 12/27/2019] [Revised: 02/18/2020] [Accepted: 02/23/2020] [Indexed: 12/17/2022]
Abstract
Background Despite the recent increase in the number of publications on diagnostic cerebral angiograms using transradial access (TRA), there have been relatively few regarding TRA for neurointerventional cases. Questions of feasibility and safety may still exist among physicians considering TRA for neurointerventional procedures. Methods A systematic literature review was performed following PRISMA guidelines. Three online databases (MedLine via PubMed, Scopus and Embase) were searched for articles published between January 2000 and December 2019. Search terms included “Transradial access”, “Radial Access”, “Radial artery” AND “Neurointerventions". The reference lists of selected articles and pertinent available non-systematic analysis were reviewed for other potential citations. Primary outcomes measured were access site complications and crossover rates. Results Twenty-one studies (n=1342 patients) were included in this review. Two of the studies were prospective while the remaining 19 were retrospective. Six studies (n=616 patients) included TRA carotid stenting only. The rest of the studies included treatment for cerebral aneurysms (n=423), mechanical thrombectomy (n=127), tumor embolization (n=22), and other indications (n=154) such as angioplasty and stenting for vertebrobasilar stenosis, balloon test occlusion, embolization of dural arteriovenous fistula and arteriovenous malformation, chemotherapeutic drug delivery, intra-arterial thrombolysis, and arterial access during a venous stenting procedure. Two (0.15%) major complications and 37 (2.75%) minor complications were reported. Sixty-four (4.77%) patients crossed over to transfemoral access for completion of the procedure. Seven (0.52%) patients crossed over due to access failure and 57 (4.24%) patients crossed over to TFA due to inability to cannulate the target vessel. Conclusion This systematic review demonstrates that TRA has a relatively low rate of access site complications and crossovers. With increasing familiarity, development of TRA-specific neuroendovascular devices, and the continued reports of its success in the literature, TRA is expected to become more widely used by neurointerventionalists.
Collapse
Affiliation(s)
- Krishna C Joshi
- Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - André Beer-Furlan
- Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - R Webster Crowley
- Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Chen
- Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Stephan A Munich
- Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
21
|
Muhsen BA, Joshi KC, Lee BS, Thapa B, Borghei-Razavi H, Jia X, Barnett GH, Chao ST, Mohammadi AM, Suh JH, Vogelbaum MA, Angelov L. The effect of Gamma Knife radiosurgery on large posterior fossa metastases and the associated mass effect from peritumoral edema. J Neurosurg 2020:1-9. [PMID: 31978879 DOI: 10.3171/2019.11.jns191485] [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: 05/26/2019] [Accepted: 11/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gamma Knife radiosurgery (GKRS) as monotherapy is an option for the treatment of large (≥ 2 cm) posterior fossa brain metastases (LPFMs). However, there is concern regarding possible posttreatment increase in peritumoral edema (PTE) and associated compression of the fourth ventricle. This study evaluated the effects and safety of GKRS on tumor and PTE control in LPFM. METHODS The authors performed a single-center retrospective review of 49 patients with 51 LPFMs treated with GKRS. Patients with at least 1 clinical and radiological follow-up visit were included. Tumor, PTE, and fourth ventricle volumetric measurements were used to assess efficacy and safety. Overall survival was a secondary outcome. RESULTS Fifty-one lesions in 49 consecutive patients were identified; 57.1% of patients were male. At the time of GKRS, the median age was 61.5 years, and the median Karnofsky Performance Status score was 90. The median number of LPFMs and overall brain metastases were 1 and 2, respectively. The median overall tumor, PTE, and fourth ventricle volumes at diagnosis were 4.96 cm3 (range 1.4-21.1 cm3), 14.98 cm3 (range 0.6-71.8 cm3), and 1.23 cm3 (range 0.3-3.2 cm3), respectively, and the median lesion diameter was 2.6 cm (range 2.0-5.07 cm). The median follow-up time was 7.3 months (range 1.6-57.2 months). At the first follow-up, 2 months posttreatment, the median tumor volume decreased by 58.66% (range -96.95% to +48.69%, p < 0.001), median PTE decreased by 78.10% (range -99.92% to +198.35%, p < 0.001), and the fourth ventricle increased by 24.97% (range -37.96% to +545.6%, p < 0.001). The local control rate at first follow-up was 98.1%. The median OS was 8.36 months. No patient required surgical intervention, external ventricular drainage, or shunting between treatment and first follow-up. However, 1 patient required a ventriculoperitoneal shunt at 23 months from treatment. Posttreatment, 65.30% received our general steroid taper, 6.12% received no steroids, and 28.58% required prolonged steroid treatment. CONCLUSIONS In this retrospective analysis, patients with LPFMs treated with GKRS had a statistically significant posttreatment reduction in tumor size and PTE and marked opening of the fourth ventricle (all p < 0.001). This study demonstrates that GKRS is well tolerated and can be considered in the management of select cases of LPFMs, especially in patients who are poor surgical candidates.
Collapse
Affiliation(s)
- Baha'eddin A Muhsen
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland; and
| | - Krishna C Joshi
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland; and
| | - Bryan S Lee
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland
| | - Bicky Thapa
- 3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland; and
| | - Hamid Borghei-Razavi
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland; and
| | - Xuefei Jia
- 2Quantitative Health Sciences, Taussig Cancer Institute, Cleveland Clinic, Cleveland
| | - Gene H Barnett
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland; and
| | - Samuel T Chao
- 3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland; and.,4Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alireza M Mohammadi
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland; and
| | - John H Suh
- 3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland; and.,4Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael A Vogelbaum
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland; and
| | - Lilyana Angelov
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland; and
| |
Collapse
|
22
|
Brahimaj BC, Beer-Furlan A, Joshi KC, Wiet RM, Lopes DK. Combined Transarterial and Transvenous Onyx Embolization of Jugular Foramen Paragangliomas. World Neurosurg 2020; 136:178-183. [PMID: 31954902 DOI: 10.1016/j.wneu.2020.01.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Jugular foramen paragangliomas are highly vascular tumors known to have significant venous hemorrhage during resection even after conventional transarterial embolization. The authors report a novel technique to the endovascular embolization of jugular foramen paragangliomas using a combined transarterial and transvenous access for better intraoperative control of blood loss and visualization. METHODS This is a retrospective data collection of 2 patients diagnosed with jugular foramen paragangliomas with novel embolization technique and surgical resection. RESULTS Two patients underwent embolization of jugular foramen paragangliomas through combined transarterial and transvenous routes using 2 double-lumen balloon microcatheters. In both cases, single arterial vessel embolization was performed through the occipital artery in Case 1 and the tympanic branch of the ascending pharyngeal artery in Case 2. Simultaneously, balloon microcatheter occlusion in the sigmoid sinus and single venous outflow vessel embolization was performed. Near-complete occlusion was established, with angiographic disappearance of tumor blush. Surgical resection was performed in both cases. Estimated blood loss BL was 600 mL in Case 1 and 200 mL in Case 2. No blood transfusions were required, intraoperatively or postoperatively. There were no cranial nerve deficits post embolization. One patient had a persistent House Brackman 2 facial nerve palsy after resection. CONCLUSIONS The initial experience with simultaneous transvenous and transarterial paraganglioma embolization demonstrated the safety of the technique and superior embolic agent penetration. This was supported by our observations during embolization and intraoperatively during tumor resection. Additional patients need to be treated with this technique for better assessment of long-term efficacy and incidence of embolization-related cranial neuropathies.
Collapse
Affiliation(s)
- Bledi C Brahimaj
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
| | - André Beer-Furlan
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Krishna C Joshi
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Richard M Wiet
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, Illinois, USA
| | - Demetrius K Lopes
- Department of Neurosurgery, Advocate Aurora Health, Chicago, Illinois, USA
| |
Collapse
|
23
|
Joshi KC, Borghei-Razavi H, Kshettry VR. Resection of anterolateral midbrain cavernous malformation via orbitozygomatic transsylvian pretemporal approach with uncal resection. Neurosurgical Focus: Video 2019; 1:V17. [PMID: 36285057 PMCID: PMC9541726 DOI: 10.3171/2019.7.focusvid.19153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/20/2019] [Indexed: 11/06/2022]
Abstract
Brainstem cavernomas are benign, angiographically occult, low-flow lesions and constitute 18%–35% of intracranial cavernomas.4,6 They are known to have an annual rupture risk of 2%–6%,2,5 and once symptomatic, they frequently cause progressive neurological morbidity. A 22-year-old lady presented with progressive profound neurologic deficits from three distinct hemorrhages over 2 months. Surgery was indicated given the aggressive natural history, and the lesion now presented to the surface with displacement of corticospinal tracts noted on diffusion tensor imaging.1,7 We describe a surgical technique via an orbitozygomatic transsylvian pretemporal approach with uncal resection to open the oculomotor-tentorial window and resect the lesion.3The video can be found here: https://youtu.be/j5yYp4OsaRc.
Collapse
|
24
|
Beer-Furlan A, Joshi KC, Dasenbrock HH, Chen M. Endovascular management of complex superior sagittal sinus dural arteriovenous fistula. Neurosurg Focus 2019; 46:V11. [PMID: 30939439 DOI: 10.3171/2019.2.focusvid.18687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/08/2019] [Indexed: 11/06/2022]
Abstract
Superior sagittal sinus (SSS) dural arteriovenous fistulas (DAVFs) are rare and present unique challenges to treatment. Complex, often bilateral, arterial supply and involvement of large volumes of eloquent cortical venous drainage may necessitate multimodality therapy such as endovascular, microsurgical, and stereotactic radiosurgery techniques. The authors present a complex SSS DAVF associated with an occluded/severely stenotic SSS. The patient underwent a successful endovascular transvenous approach with complete obliteration of the SSS. The authors discuss the management challenges faced on this case.The video can be found here: https://youtu.be/-rztg0_cBXY.
Collapse
|
25
|
Beer-Furlan A, Dasenbrock HH, Joshi KC, Chen M. Transarterial and transvenous approaches for embolization of tentorial dural arteriovenous fistula. Neurosurg Focus 2019; 46:V10. [DOI: 10.3171/2019.2.focusvid.18690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/08/2019] [Indexed: 11/06/2022]
Abstract
Tentorial dural arteriovenous fistulas (DAVFs) are uncommon, complex fistulas located between the leaves of the tentorium cerebelli with a specific anatomic and clinical presentation characterized by high hemorrhagic risk. They have an extensive arterial supply and complex venous drainages, making them difficult to treat. There is recent literature favoring treatment through an endovascular transarterial route. The authors present an uncommon tentorial/ambient cistern region DAVF with feeders arising from the external and internal carotid arteries. The patient underwent a combined transarterial and transvenous approach with successful obliteration of the DAVF. The authors discuss the management challenges faced in this case.The video can be found here: https://youtu.be/VXDD8zUvsSQ.
Collapse
|
26
|
Joshi KC, Heiferman DM, Beer-Furlan A, Lopes DK. Stent-assisted coil embolization of MCA aneurysm via a trans-posterior communicating artery access. Neurosurg Focus 2019; 46:V3. [DOI: 10.3171/2019.1.focusvid.18444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/19/2018] [Indexed: 11/06/2022]
Abstract
External carotid artery (ECA) to internal carotid artery (ICA) bypass is a well-established procedure for the treatment of chronic ischemic diseases of the carotid artery. Rarely de novo aneurysms can develop at the site of anastomosis. The treatment of these aneurysms can be very challenging due to various factors, including the presence of graft, previous craniotomy, atherosclerotic vessels, and lack of direct access. In this video the authors report and discuss the management of a right middle cerebral artery (MCA) wide-necked de novo aneurysm by stent-assisted coiling through a retrograde trans-posterior communicating artery access.The video can be found here: https://youtu.be/MBKolPvOErU.
Collapse
Affiliation(s)
- Krishna C. Joshi
- 1Department of Neurological Surgery, Rush University Medical Center, Chicago
| | - Daniel M. Heiferman
- 2Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood; and
| | - André Beer-Furlan
- 1Department of Neurological Surgery, Rush University Medical Center, Chicago
| | - Demetrius K. Lopes
- 3Cerebrovascular Neurosurgery and Comprehensive Stroke Center, Chicago, Illinois
| |
Collapse
|
27
|
Beer-Furlan A, Dasenbrock HH, Joshi KC, Chen M. Endovascular management of basilar artery occlusion secondary to fusiform aneurysm with intraluminal thrombus. Neurosurg Focus 2019; 46:V2. [PMID: 30611176 DOI: 10.3171/2019.1.focusvid.18468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/18/2018] [Indexed: 11/06/2022]
Abstract
Acute basilar artery occlusion is one of the most devastating subtypes of ischemic stroke with an extremely high morbidity and mortality rate. The most common causes include embolism, large-artery atherosclerosis, penetrating small-artery disease, and arterial dissection. The heart and vertebral arteries are the main source of emboli in embolic basilar occlusions. The authors present an uncommon acute basilar occlusion secondary to a fusiform aneurysm with intraluminal thrombus. The patient underwent a mechanical thrombectomy with successful recanalization, but persistent intraluminal thrombus. The authors discuss the management dilemma and describe their choice for placement of flow diverter stents.The video can be found here: https://youtu.be/XzBdgxJPSWQ.
Collapse
|
28
|
Perikal PJ, Srikantha U, Joshi KC, J AJ, Khanapure K, Varma RG, Hegde SA. Minimally Invasive Augmented Fixation for Anatomical Reduction of Grade 2 and Grade 3 Listhesis in Patients with Osteoporosis. Asian Spine J 2018; 12:887-892. [PMID: 30213172 PMCID: PMC6147869 DOI: 10.31616/asj.2018.12.5.887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/05/2018] [Indexed: 11/25/2022] Open
Abstract
Study Design A retrospective study. Purpose To study the efficacy of augmented fixation for anatomical reduction of grade 2 and grade 3 listhesis in patients with osteoporosis. Overview of Literature Spondylolisthesis in osteoporotic patients requiring spinal fixation are associated with complications such as loss of surgical construct stability, screw pulling out, and screw loosening. Augmented fixation is a novel strategy to achieve necessary construct integrity. Methods Thirteen consecutive patients with grade 2 or grade 3 listhesis, with proven osteoporosis on dual energy X-ray absorptiometry (DEXA) scan, and who underwent augmented fixation for reduction of listhesis were retrospectively analyzed. In all patients, surgical access was achieved with a fixed 22 mm tubular retractor. A modified technique of bilateral, sequential, transforaminal decompression and discectomy, followed by reduction of listhesis using unilaterally placed augmented screws was employed in all the cases. Patients were followed up with plain X-rays at regular intervals to assess for implant stability and fusion status. All patients were started on medical treatment for osteoporosis. Results The mean age of the patients was 52.46 years, with 12 females and one male. The median T-score on DEXA scan was −3.0. Of the 13 patients, listhesis was at L4–L5 in five and at L5–S1 in eight. Nine patients had grade 2 listhesis, while four patients had grade 3 listhesis. Complete reduction was achieved in 10 patients. The median duration of follow-up was 18 months. Postoperative outcomes were satisfactory in all cases. Conclusions Augmented fixation is a useful technique for achieving anatomical reduction of listhesis in patients with osteoporosis.
Collapse
Affiliation(s)
- Parichay J Perikal
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, India
| | - Umesh Srikantha
- Department of Neurosurgery, Aster CMI Hospital, Bangalore, India
| | - Krishna C Joshi
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, India
| | - Aniruddha Jagannath J
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, India
| | - Kiran Khanapure
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, India
| | - Ravi Gopal Varma
- Department of Neurosurgery, Aster CMI Hospital, Bangalore, India
| | - Sathyaranjandas Alanga Hegde
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, India
| |
Collapse
|
29
|
Parichay PJ, Khanapure K, Aniruddha TJ, Mahendra JV, Joshi KC, Furtado SV, Hegde AS. Curious Case of a Medullary Lesion following Pontine Cavernoma Resection. JMSH 2017. [DOI: 10.46347/jmsh.2017.v03i02.007] [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: 10/24/2022] Open
|
30
|
Parichay PJ, Khanapure K, Joshi KC, Aniruddha TJ, Sandhya M, Hegde AS. Clinical and radiological assessment of cerebral hemodynamics after cranioplasty for decompressive craniectomy - A Clinical study. J Clin Neurosci 2017; 42:97-101. [PMID: 28457859 DOI: 10.1016/j.jocn.2017.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 01/15/2017] [Accepted: 04/03/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To find the correlation between radiologically proven improvement in cerebral hemodynamics with clinical improvement in patients undergoing cranioplasty. MATERIAL AND METHODS The study is a prospective observational study of 10 cases, in M S Ramaiah Institute of Neurosciences, involving patients treated by a decompressive craniectomy for intractable intra cranial hypertension either due to trauma or stroke and afterwards underwent cranioplasty. RESULTS Of the 10 patients, 70% patients showing significant improvement in motor functions on Barthel index scale, 60% patients showed improvement in speech, mean duration from date of decompressive craniectomy to cranioplasty being 122.4days. Cerebral perfusion was remarkably better after cranioplasty, as demonstrated decrease in the Pulsatility index on the ipsilateral side of decompression on Trans cranial Doppler (<0.73 mean). This data also favored improved cerebral blood flow and permeability on the CT perfusion with increase in cerebral blood flow (CBF), Cerebral Blood Volume (CBV) and decrease in Time to Peak (TTP) and a positive outcome when correlated with Barthel index with P-values of 0.093, 0.017 and 0.001 respectively. CONCLUSION Cranioplasty influences the cerebral hemodynamics after cranioplasty and has a positive correlation on the functional outcome and cerebral blood flow in the MCA territory.
Collapse
Affiliation(s)
- Perikal J Parichay
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, New BEL Road, Bangalore 54, India.
| | - Kiran Khanapure
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, New BEL Road, Bangalore 54, India
| | - Krishna C Joshi
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, New BEL Road, Bangalore 54, India
| | - T J Aniruddha
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, New BEL Road, Bangalore 54, India
| | - M Sandhya
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India
| | - A S Hegde
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, New BEL Road, Bangalore 54, India
| |
Collapse
|
31
|
Srikantha U, Khanapure KS, Jagannatha AT, Joshi KC, Varma RG, Hegde AS. Minimally invasive atlantoaxial fusion: cadaveric study and report of 5 clinical cases. J Neurosurg Spine 2016; 25:675-680. [DOI: 10.3171/2016.5.spine151459] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Minimally invasive techniques are being increasingly used to treat disorders of the cervical spine. They have a potential to reduce the postoperative neck discomfort subsequent to extensive muscle dissection associated with conventional atlantoaxial fusion procedures. The aim of this paper was to elaborate on the technique and results of minimally invasive atlantoaxial fusion.
MATERIALS
Minimally invasive atlantoaxial fusion was done initially in 4 fresh-frozen cadavers and subsequently in 5 clinical cases. Clinical cases included patients with reducible atlantoaxial instability and undisplaced or minimally displaced odontoid fractures. The surgical technique is illustrated in detail.
RESULTS
Among the cadaveric specimens, all C-1 lateral mass screws were in the correct position and 2 of the 8 C-2 screws had a vertebral canal breach. Among clinical cases, all C-1 lateral mass screws were in the correct position. Only one C-2 screw had a Grade 2 vertebral canal breach, which was clinically insignificant. None of the patients experienced neurological worsening or implant-related complications at follow-up. Evidence of rib graft fusion or C1–2 joint fusion was successfully demonstrated in 4 cases, and flexion-extension radiographs done at follow-up did not show mobility in any case.
CONCLUSIONS
Minimally invasive atlantoaxial fusion is a safe and effective alternative to the conventional approach in selected cases. Larger series with direct comparison to the conventional approach will be required to demonstrate clinical benefit presumed to be associated with a minimally invasive approach.
Collapse
|
32
|
Abstract
Juglone and lawsone, both acid-base indicators, obtained from natural sources and give pink and red colours with aqueous alkalies, respectively. Their transition ranges are found to be pH 7.4–8.2 and 2.6–3.4. To establish the transition intervals, a buffer series ranging in the pH values from 2.0–2.2–2.4–2.6–2.8–3.0–3.2–3.4–3.6–3.8–4.0–4.2–4.4–4.6–4.8–5.0–5.2–5.4–5.6–5.8–6.0–6.2–6.4–6.6–6.8–7.0–7.2–7.4–7.6–7.8–8.0–8.2–8.4–8.6–8.8–9.0 has been used. Juglone can be used for the titrations of strong acids with strong bases and weak acids with strong bases and lawsone can be used for the titration of strong acids with weak bases only. Permanancy of the colours at the end point is one of their advantages.
Collapse
Affiliation(s)
| | - P. Singh
- Department of Chemistry, University of Rajasthan, Jaipur, India
| | - G. Singh
- Department of Chemistry, University of Rajasthan, Jaipur, India
| |
Collapse
|
33
|
Abstract
From the aqueous extract of the heartwood of Gmelina arborea (N.O.: Verbenaceae), a lignan has been isolated and identified as gmelinol on the basis of its chemical and spectral analysis. From the benzene extract of the same heartwood, n-octacosanol has been isolated as one of the constituents.
Collapse
Affiliation(s)
- Krishna C. Joshi
- Organic Chemistry Laboratories, University of Rajasthan, Jaipur-4
| | - L. B. Singh
- Organic Chemistry Laboratories, University of Rajasthan, Jaipur-4
| |
Collapse
|
34
|
Joshi KC, Singh H, Sakhuja P, Singh D. Repeated hydrocephalus in recurrent intraventricular neurocysticercosis: An uncommon presentation. J Neurosci Rural Pract 2013; 4:87-9. [PMID: 23546368 PMCID: PMC3579065 DOI: 10.4103/0976-3147.105630] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A rare case of a 42-years old man presented with repeated hydrocephalus due to the neurocysticercosis cyst (NCC) in the lateral ventricle. Patient was operated previously 2½ years back for a similar lesion at same site. Both times he was treated endoscopically with removal of the cyst. Interestingly there was no parenchymatous lesion at any stage of follow up. Isolated recurrent intraventricular NCC is a rare condition that has never been reported in the literature.
Collapse
Affiliation(s)
- Krishna C Joshi
- Department of Neurosurgery, G B Pant Hospital, New Delhi, India
| | | | | | | |
Collapse
|
35
|
Joshi KC, Jain R, Dandia A, Garg S, Ahmed N. Studies in spiroheterocycles. Part XIII. Synthesis of a novel spiro system: Spiro[9H-acridine-9,3′-[3h]indol]-2′(1′H)-one and related compounds from new fluorinated spiro[3H-indole-3,9′-[9H]xanthen]-2(1H)-ones. J Heterocycl Chem 2009. [DOI: 10.1002/jhet.5570260649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
36
|
Joshi KC, Pathak VN, Sharma S. SYNTHESIS AND ELECTROPHILIC SUBSTITUTION REACTIONS OF FLUORINE CONTAINING ARYLGLYOXAL 2-ARYLHYDRAZONES. ORG PREP PROCED INT 2009. [DOI: 10.1080/00304948509355489] [Citation(s) in RCA: 3] [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: 10/20/2022]
|
37
|
Affiliation(s)
- Krishna C. Joshi
- a Department of Chemistry , University of Rajasthan , Jaipur , 302004 , India
| | - Diwakar Sharma
- a Department of Chemistry , University of Rajasthan , Jaipur , 302004 , India
| | - Bidya S. Joshi
- a Department of Chemistry , University of Rajasthan , Jaipur , 302004 , India
| |
Collapse
|
38
|
Joshi KC, Tholia MK. Organic pesticides. XV. Synthesis and insecticidal activity of some compounds containing phosphorus and fluorine. ACTA ACUST UNITED AC 2006. [DOI: 10.1002/ps.2780040511] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
39
|
|
40
|
|
41
|
|
42
|
Joshi KC, Bohra R, Joshi BS. Studies of fluorinated 1,3-diketones and related compounds. 17. Benzoic acid hydrazide derivatives of 1,3-diketones and their nickel complexes. Molecular structures of [cyclic]C6H5C(:O)NN:C(p-FC6H4)CH2C(OH)(p-FC6H4) and [cyclic][C6H5C(O):NN:C(p-FC6H4)CH:C(O)(p-FC6H4)-O,N]Ni(NH3). Inorg Chem 2002. [DOI: 10.1021/ic00030a014] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
43
|
Bajpai SN, Joshi KC, Jain R. ROLE OF FLUORINE IN CYCLOCONDENSATION OF 3-ARYLIMINO-2H-INDOL-2-ONES WITH o-MERCAPTOBENZOIC ACID. HETEROCYCL COMMUN 1997. [DOI: 10.1515/hc.1997.3.1.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
44
|
Pathak VN, Chaturvedi RK, Sharma S, Jain M, Joshi KC. Non-steroidal antifertility agents. Pharmazie 1993; 48:323-39. [PMID: 8327560] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- V N Pathak
- Department of Chemistry, University of Rajasthan, Jaipu, India
| | | | | | | | | |
Collapse
|
45
|
|
46
|
Joshi KC, Kandpal HC, Vaishya JS. Spectral shift due to source correlation in conventional spectroradiometric measurements. Appl Opt 1991; 30:1471-1473. [PMID: 20700307 DOI: 10.1364/ao.30.001471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Keeping in view the recent findings of the spectral shift due to source correlation during propagation of light, a study has been undertaken to analyze the errors which may be introduced in spectroradiometric measurements.
Collapse
|
47
|
C. Majumdar K, C. Joshi K, T. Pardasani R, Dandia A, Bhagat (nee Baweja) S. Thermal and Photochemical Investigation of the Reaction of Indole-2,3-dione with Pyrazolone. HETEROCYCLES 1991. [DOI: 10.3987/com-90-5550] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
48
|
Joshi KC, Dandia A, Bhagat S. Synthesis, 19F NMR spectral studies and antibacterial evaluation of some new fluorine containing indole derivatives. J Fluor Chem 1990. [DOI: 10.1016/s0022-1139(00)80431-5] [Citation(s) in RCA: 25] [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] [Indexed: 10/18/2022]
|
49
|
Kandpal HC, Vaishya JS, Joshi KC. Simple experimental arrangement for observing spectral shifts due to source correlation. Phys Rev A 1990; 41:4541-4542. [PMID: 9903659 DOI: 10.1103/physreva.41.4541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
50
|
Joshi KC, Sharma AK, Joshi BS. Studies in fluorinated 1,3-diketones and related compounds. Part XVI: Mixed ligand complexes of ruthenium with fluorinated 1,3-diketones. J Fluor Chem 1990. [DOI: 10.1016/s0022-1139(00)80442-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|