1
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Urcuyo JC, Curtin L, Langworthy JM, De Leon G, Anderies B, Singleton KW, Hawkins-Daarud A, Jackson PR, Bond KM, Ranjbar S, Lassiter-Morris Y, Clark-Swanson KR, Paulson LE, Sereduk C, Mrugala MM, Porter AB, Baxter L, Salomao M, Donev K, Hudson M, Meyer J, Zeeshan Q, Sattur M, Patra DP, Jones BA, Rahme RJ, Neal MT, Patel N, Kouloumberis P, Turkmani AH, Lyons M, Krishna C, Zimmerman RS, Bendok BR, Tran NL, Hu LS, Swanson KR. Image-localized biopsy mapping of brain tumor heterogeneity: A single-center study protocol. PLoS One 2023; 18:e0287767. [PMID: 38117803 PMCID: PMC10732423 DOI: 10.1371/journal.pone.0287767] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/13/2023] [Indexed: 12/22/2023] Open
Abstract
Brain cancers pose a novel set of difficulties due to the limited accessibility of human brain tumor tissue. For this reason, clinical decision-making relies heavily on MR imaging interpretation, yet the mapping between MRI features and underlying biology remains ambiguous. Standard (clinical) tissue sampling fails to capture the full heterogeneity of the disease. Biopsies are required to obtain a pathological diagnosis and are predominantly taken from the tumor core, which often has different traits to the surrounding invasive tumor that typically leads to recurrent disease. One approach to solving this issue is to characterize the spatial heterogeneity of molecular, genetic, and cellular features of glioma through the intraoperative collection of multiple image-localized biopsy samples paired with multi-parametric MRIs. We have adopted this approach and are currently actively enrolling patients for our 'Image-Based Mapping of Brain Tumors' study. Patients are eligible for this research study (IRB #16-002424) if they are 18 years or older and undergoing surgical intervention for a brain lesion. Once identified, candidate patients receive dynamic susceptibility contrast (DSC) perfusion MRI and diffusion tensor imaging (DTI), in addition to standard sequences (T1, T1Gd, T2, T2-FLAIR) at their presurgical scan. During surgery, sample anatomical locations are tracked using neuronavigation. The collected specimens from this research study are used to capture the intra-tumoral heterogeneity across brain tumors including quantification of genetic aberrations through whole-exome and RNA sequencing as well as other tissue analysis techniques. To date, these data (made available through a public portal) have been used to generate, test, and validate predictive regional maps of the spatial distribution of tumor cell density and/or treatment-related key genetic marker status to identify biopsy and/or treatment targets based on insight from the entire tumor makeup. This type of methodology, when delivered within clinically feasible time frames, has the potential to further inform medical decision-making by improving surgical intervention, radiation, and targeted drug therapy for patients with glioma.
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Affiliation(s)
- Javier C Urcuyo
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Lee Curtin
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Jazlynn M. Langworthy
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Gustavo De Leon
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Barrett Anderies
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Kyle W. Singleton
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Andrea Hawkins-Daarud
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Pamela R. Jackson
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Kamila M. Bond
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Sara Ranjbar
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Yvette Lassiter-Morris
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Kamala R. Clark-Swanson
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Lisa E. Paulson
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Chris Sereduk
- Department of Cancer Biology, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Maciej M. Mrugala
- Department of Neurology, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Oncology, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Alyx B. Porter
- Department of Neurology, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Oncology, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Leslie Baxter
- Department of Neurophysiology, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Marcela Salomao
- Department of Pathology, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Kliment Donev
- Department of Pathology, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Miles Hudson
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Jenna Meyer
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Qazi Zeeshan
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Mithun Sattur
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Devi P. Patra
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Breck A. Jones
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Rudy J. Rahme
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Matthew T. Neal
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Naresh Patel
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Pelagia Kouloumberis
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Ali H. Turkmani
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Mark Lyons
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Chandan Krishna
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Richard S. Zimmerman
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Bernard R. Bendok
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Nhan L. Tran
- Department of Cancer Biology, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Leland S. Hu
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Kristin R. Swanson
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Cancer Biology, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, United States of America
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2
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Abi-Aad KR, Rahme RJ, Syal A, De La Peña NM, Turcotte EL, Patra DP, Jones B, Chong B, Krishna C, Bendok BR. Predictive Model Evaluating Risk of Hemorrhage in Intracranial Aneurysms: Analysis from Prospectively Collected HEAT Trial Database. World Neurosurg 2023; 178:e315-e322. [PMID: 37479031 DOI: 10.1016/j.wneu.2023.07.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE We analyzed the data of patients enrolled in the Hydrogel Endovascular Aneurysm Treatment (HEAT) trial to develop and validate a model to predict the risk of aneurysmal hemorrhage. METHODS Analysis included data from 600 patients enrolled for the HEAT trial and included single saccular aneurysms of 3-14 mm size. Baseline characteristics were compared between patients with ruptured and unruptured aneurysms. Regression analysis was performed in the training set to identify significant risk factors and was validated in the validation dataset. The complete dataset was used to formulate a scoring model in which positive and negative predictors were assigned 1 and -1 points, respectively. RESULTS Data from 593 patients were analyzed in which 169 (28.5%) patients had ruptured aneurysms. The training (n = 297) and validation dataset (n = 296) had a comparable proportion of ruptured aneurysms (29.3% and 27.7%). Dome-to-neck ratio >2.5 (odds ratio [OR] 3.66), irregular shape (OR 3.79), daughter sac (OR 5.89), and anterior and posterior communicating artery locations (OR 3.32 and 3.56, respectively) had a higher rupture rate. Use of aspirin was associated with lower risk of hemorrhage (OR 0.16). The area under the curve from the receiver operating curve analysis was 0.88, 0.87, and 0.87 in the training, validation, and combined data set, respectively. The scoring model created a score of -1 to 2, yielding an of aneurysmal hemorrhage probability from 1.5% (score -1) to 70% (score 2). CONCLUSIONS This prospective study identifies dome-to-neck ratio >2.5, irregular shape, presence of daughter sac, absence of aspirin use, and aneurysm location at anterior communicating and posterior communicating artery as factors associated with increased risk of hemorrhagic presentation in small- to medium-sized intracranial aneurysms. Our model provides an estimate of rupture risk based on the presence or absence of these factors.
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Affiliation(s)
- Karl R Abi-Aad
- Department of Neurosurgery, SUNY Upstate University, New York, New York, USA; Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA
| | - Rudy J Rahme
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA; Department of Neurosurgery, Global Neurosciences Institute, Pennington, New Jersey, USA; Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Arjun Syal
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, New York Medical College, Valhalla, New York, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Nicole M De La Peña
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA; Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | - Evelyn L Turcotte
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA; Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | - Devi P Patra
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA; Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Breck Jones
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA; Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA; Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA
| | - Brian Chong
- Precision Neuro-Therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Chandan Krishna
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Bernard R Bendok
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA; Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-Therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA.
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3
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Stuebe C, Jones BA, Syal A, Rahme RJ, Turcotte EL, Toussaint LG, Ross JS, Bendok BR. Cerebrospinal Venous Fistula Presenting with Cognitive Decline: Systematic Literature Review and Report of Two Cases. World Neurosurg 2023; 176:74-80. [PMID: 36934870 DOI: 10.1016/j.wneu.2023.03.056] [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: 02/24/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE A cerebrospinal fluid (CSF) venous fistula (CVF) is an aberrant connection between the subarachnoid space and a vein resulting in CSF loss. The presentation and management of CVF with cognitive decline is incompletely understood. METHODS A systematic review was completed following the PRISMA guidelines. Articles that included at least 1 case of imaging-confirmed CVF with details on patient treatment were included. A separate review of cases of patients with spontaneous intracranial hypotension (SIH) with frontotemporal dementia (FTD) or dementia symptoms was also completed. RESULTS Ten CVF articles (69 patients; average age, 51.5 years) and 5 SIH with FTD or dementia articles (n = 41; average age, 55.9 years) were identified. Only 1 patients with CVF with cognitive abnormalities was identified. The most common symptom was headache in both reviews. Brain sag was identified in all patients, whereas CSF leak was identified in only 2 patients with SIH with FTD or dementia (4.9%). An epidural blood or fibrin glue patch was used in all patients with CVF and in 33 patients with SIH with FTD or dementia. Fifty-five patients with CVF (79.7%) and 27 patients with SIH with FTD or dementia (65.9%) had surgery. CONCLUSIONS The 2 cases and literature reviews show the difficulty in diagnosis and treatment of CVF with cognitive decline. Novel imaging techniques should be used in patients with cognitive decline in whom a CSF leak is suspected. Transvenous embolization or surgery should be considered before patching for treatment of CVF-induced brain sag and resulting dementia.
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Affiliation(s)
- Caren Stuebe
- Texas A&M College of Medicine, Bryan, Texas, USA
| | - Breck A Jones
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-Therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Arjun Syal
- New York Medical College, Valhalla, New York, USA
| | - Rudy J Rahme
- Department of Neurosurgery, Global Neuroscience Institute, Philadelphia, Pennsylvania, USA
| | - Evelyn L Turcotte
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-Therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - L Gerard Toussaint
- Texas A&M College of Medicine, Bryan, Texas, USA; Texas Brain and Spine Institute, Bryan, Texas, USA
| | - Jeffrey S Ross
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
| | - Bernard R Bendok
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-Therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA.
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4
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Patra DP, Syal A, Rahme RJ, Abi-Aad KR, Singh R, Turcotte EL, Jones BA, Meyer J, Hudson M, Chong BW, Dabus G, James RF, Krishna C, Bendok BR. A comparison of treating physician versus independent core lab assessments of post-aneurysm treatment imaging outcomes: an analysis of prospectively collected data from a randomized trial. J Neurosurg 2022:1-9. [PMID: 36681980 DOI: 10.3171/2022.10.jns22841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Aneurysm occlusion has been used as surrogate marker of aneurysm treatment efficacy. Aneurysm occlusion scales are used to evaluate the outcome of endovascular aneurysm treatment and to monitor recurrence. These scales, however, require subjective interpretation of imaging data, which can reduce the utility and reliability of these scales and the validity of clinical studies regarding aneurysm occlusion rates. Use of a core lab with independent blinded reviewers has been implemented to enhance the validity of occlusion rate assessments in clinical trials. The degree of agreement between core labs and treating physicians has not been well studied with prospectively collected data. METHODS In this study, the authors analyzed data from the Hydrogel Endovascular Aneurysm Treatment (HEAT) trial to assess the interrater agreement between the treating physician and the blinded core lab. The HEAT trial included 600 patients across 46 sites with intracranial aneurysms treated with coiling. The treating site and the core lab independently reviewed immediate postoperative and follow-up imaging (3-12 and 18-24 months, respectively) using the Raymond-Roy occlusion classification (RROC) scale, Meyer scale, and recanalization survey. A post hoc analysis was performed to calculate interrater reliability using Cohen's kappa. Further analysis was performed to assess whether degree of agreement varied on the basis of various factors, including scale used, timing of imaging, size of the aneurysm, imaging modality, location of the aneurysm, dome-to-neck ratio, and rupture status. RESULTS Minimal interrater agreement was noted between the core lab reviewers and the treating physicians for assessing aneurysm occlusion using the RROC grading scale (k = 0.39, 95% CI 0.38-0.40) and Meyer scale (k = 0.23, 95% CI 0.14-0.38). The degree of agreement between groups was slightly better but still weak for assessing recanalization (k = 0.45, 95% CI 0.38-0.52). Factors that significantly improved degree of agreement were scales with fewer variables, greater time to follow-up, imaging modality (digital subtraction angiography), and wide-neck aneurysms. CONCLUSIONS Assessment of aneurysm treatment outcome with commonly used aneurysm occlusion scales suffers from risk of poor interrater agreement. This supports the use of independent core labs for validation of outcome data to minimize reporting bias. Use of outcome tools with fewer point categories is likely to provide better interrater reliability. Therefore, the outcome assessment tools are ideal for clinical outcome assessment provided that they are sensitive enough to detect a clinically significant change.
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Affiliation(s)
- Devi P Patra
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix.,2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix.,3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Arjun Syal
- 4New York Medical College, Valhalla, New York
| | - Rudy J Rahme
- 5Department of Neurosurgery, Global Neuroscience Institute, Philadelphia, Pennsylvania
| | | | - Rohin Singh
- 7Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Evelyn L Turcotte
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix.,2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix.,3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Breck A Jones
- 3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona.,8Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Jenna Meyer
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix.,2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix.,3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Miles Hudson
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix.,2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix.,3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Brian W Chong
- 12Department of Radiology, Mayo Clinic, Phoenix, Arizona
| | - Guilherme Dabus
- 9Department of Neuroradiology, Miami Neuroscience Institute, Baptist Health South Florida, Miami, Florida
| | - Robert F James
- 10Department of Neurosurgery, IU Health Physicians Neurosurgery, Indianapolis, Indiana
| | - Chandan Krishna
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix.,2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix.,3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Bernard R Bendok
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix.,2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix.,3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona.,11Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix.,12Department of Radiology, Mayo Clinic, Phoenix, Arizona
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5
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Perez-Vega C, Domingo RA, Tripathi S, Ramos-Fresnedo A, Martínez Santos JL, Rahme RJ, Freeman WD, Sandhu SS, Miller DA, Bendok BR, Brinjikji W, Quinones-Hinojosa A, Meyer FB, Tawk RG, Fox WC. Intracranial Aneurysms in Loeys-Dietz Syndrome: A Multicenter Propensity-Matched Analysis. Neurosurgery 2022; 91:541-546. [PMID: 35876667 DOI: 10.1227/neu.0000000000002070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Loeys-Dietz syndrome (LDS) is an autosomal dominant connective tissue disorder characterized by a classic triad of hypertelorism, bifid uvula and/or cleft palate, and generalized arterial tortuosity. There are limited data on the prevalence and rupture risk of intracranial aneurysms (IAs) in the setting of LDS, with no established guidelines. OBJECTIVE To analyze the prevalence and rupture risk of IA in LDS. METHODS Electronic medical records of patients with a confirmed diagnosis of LDS and available cerebrovascular imaging were reviewed. Patients were divided into 2 groups based on the presence of IA. Unmatched and propensity-matched analyses were used to identify potential risk factors for aneurysm formation. RESULTS Records of 1111 patients were screened yielding a total of 60 patients with a diagnosis of LDS. Eighteen (30%) patients had IA, 4 (22.2%) of whom had multiple aneurysms for a total of 24 IAs. Twenty-three (95.8%) aneurysms were located in the anterior circulation; none of them were ruptured. On unmatched analysis, age ( P = .015), smoking history ( P = .034), hypertension ( P = .035), and number of extracranial aneurysms ( P < .001) were significantly higher in patients with IA. After matching for age, sex, race, stroke history, family history, and extracranial aneurysms, smoking history ( P = .009) remained significant. CONCLUSION Patients with LDS have an increased risk of IAs, especially with a history of smoking. The prevalence rate of IAs in our series was 30%. Screening imaging should be considered at diagnosis, and patients should be encouraged to abstain from smoking. Further studies are needed to elucidate the risk of IA rupture and treatment considerations in this unique population.
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Affiliation(s)
- Carlos Perez-Vega
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Ricardo A Domingo
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Shashwat Tripathi
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA.,Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Jaime L Martínez Santos
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA.,Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rudy J Rahme
- Department of Neurologic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | | | | | - David A Miller
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Bernard R Bendok
- Department of Neurologic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | | | | | - Fredric B Meyer
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rabih G Tawk
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - W Christopher Fox
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
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6
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Weisskopf PA, Turcotte EL, Rahme RJ, Bendok BR. Middle Fossa Approach for Resection of a Petrous Apex Cholesterol Granuloma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 23:e322-e323. [PMID: 36103353 DOI: 10.1227/ons.0000000000000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 05/24/2022] [Indexed: 11/19/2022] Open
Abstract
Cholesterol granulomas (CGs) are the most common cyst of the petrous apex.1 The management options for CG include observation and surgical resection. Surgery is complicated by the proximity of these lesions to critical neurological and vascular structures, as with many skull base lesions; however, if left untreated, their growth may lead to mass effect resulting in conductive hearing loss, cranial nerve dysfunction, tinnitus, and/or chronic headaches.2,3 In this video, we present the case of 52-year-old woman who presented with medically refractory right retro-orbital headaches. MRI revealed a large, right-sided petrous apex cystic structure consistent with a CG. Computed tomography of the head demonstrated bony remodeling. Given the large size of the cyst and the patient's symptoms, surgery was proposed, and the patient agreed. We performed a middle fossa craniotomy and elevated the dura from the floor of the middle fossa, working posteriorly from the petrous ridge and extending anteriorly. The cyst was exposed and decompressed, and its wall was then dissected off. After all cystic components were removed, the cavity was packed with abdominal fat, which is believed to prevent cyst reaccumulation. Postoperative MRI demonstrated good resection, and the patient reported complete resolution of her headaches. The patient consented to the procedure as shown in this operative video and gave informed written consent for use of her images in publication.
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Affiliation(s)
| | - Evelyn L Turcotte
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA.,Precision Neuro-Therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Rudy J Rahme
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA.,Precision Neuro-Therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Bernard R Bendok
- Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA.,Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA.,Precision Neuro-Therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA.,Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
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7
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Rahme RJ, Turcotte EL, Patra DP, Welz ME, Batjer HH, Bendok BR. Normalization of Peri-Arteriovenous Malformation Hemodynamics Prior to Direct Microsurgery: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E541-E542. [PMID: 34560779 DOI: 10.1093/ons/opab302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/02/2021] [Indexed: 11/14/2022] Open
Abstract
Arteriovenous malformations (AVMs) are highly complex vascular lesions characterized by abnormal connections between arteries and an intervening nidus. Definitive and safe treatment of AVMs may require the combination of multiple treatment modalities to address the various complex features of the AVM.1 Endovascular embolization can be used as an adjuvant to surgery in order to control deep feeders, reduce flow, and address high-risk features such as aneurysms. In addition, by progressively reducing the AVM flow, staged embolization can lead to normalization of peri-AVM hemodynamics and therefore may decrease the risk of postresection hemorrhage.2,3 In this operative video, we present a case of a 41-yr-old female who presented with progressively worsening left-sided hemiparesis. Magnetic resonance imaging (MRI) and angiography revealed a complex right fronto-parietal AVM with significant associated edema, likely due to the vascular steal phenomenon. The area of edema, which included the motor cortex, was thought to be at high risk for postoperative hemorrhage from normal perfusion pressure breakthrough. We therefore decided to proceed with staged presurgical embolization to gradually normalize the perilesional hemodynamics, and therefore possibly reduce the risk of postoperative morbidity. The patient underwent 3 embolization sessions at 6-wk intervals. An MRI after the last embolization showed near-complete resolution of the fluid-attenuated inversion-recovery (FLAIR) signal around the AVM. Microsurgical resection was performed on the day after the last embolization. The patient tolerated the procedure well and was discharged at her neurological baseline with mild contralateral hemiparesis, which has continued to improve at follow-up. Postoperative angiography showed complete resection of the AVM. The patient consented to the procedure as shown in this operative video and gave informed written consent for use of her images in publication.
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Affiliation(s)
- Rudy J Rahme
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Evelyn L Turcotte
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Devi P Patra
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Matthew E Welz
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - H Hunt Batjer
- Neurological Surgery, Southwestern Medical Center, University of Texas, Dallas, Texas, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA.,Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA.,Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
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8
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Richter KR, Turcotte EL, Hess RA, Patra DP, Rahme RJ, Tate MC, Bendok BR. Awake Resection of an Arteriovenous Malformation. World Neurosurg 2021; 162:17. [PMID: 34245878 DOI: 10.1016/j.wneu.2021.06.146] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Kent R Richter
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ
| | - Evelyn L Turcotte
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, AZ; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, AZ
| | - Ryan A Hess
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, AZ; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, AZ
| | - Devi P Patra
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, AZ; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, AZ
| | - Rudy J Rahme
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, AZ; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, AZ
| | - Matthew C Tate
- Departments of Neurological Surgery and Neurology, Northwestern University, Chicago, IL
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ; Department of Otolaryngology, Mayo Clinic, Phoenix, AZ; Department of Radiology, Mayo Clinic, Phoenix, AZ; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, AZ; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, AZ.
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9
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Bendok BR, Abi-Aad KR, Ward JD, Kniss JF, Kwasny MJ, Rahme RJ, Aoun SG, El Ahmadieh TY, El Tecle NE, Zammar SG, Aoun RJN, Patra DP, Ansari SA, Raymond J, Woo HH, Fiorella D, Dabus G, Milot G, Delgado Almandoz JE, Scott JA, DeNardo AJ, Dashti SR. The Hydrogel Endovascular Aneurysm Treatment Trial (HEAT): A Randomized Controlled Trial of the Second-Generation Hydrogel Coil. Neurosurgery 2020; 86:615-624. [PMID: 32078692 PMCID: PMC7534546 DOI: 10.1093/neuros/nyaa006] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/12/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Aneurysm recurrence after coiling has been associated with aneurysm growth, (re)hemorrhage, and a greater need for follow-up. The second-generation HydroCoil Embolic System (HES; MicroVention, Inc) consists of a platinum core with integrated hydrogel and was developed to reduce recurrence through enhancing packing density and healing within the aneurysm. OBJECTIVE To compare recurrence between the second-generation HES and bare platinum coil (BPC) in the new-generation Hydrogel Endovascular Aneurysm Treatment Trial (HEAT). METHODS HEAT is a randomized, controlled trial that enrolled subjects with ruptured or unruptured 3- to 14-mm intracranial aneurysms amenable to coiling. The primary endpoint was aneurysm recurrence using the Raymond-Roy scale. Secondary endpoints included minor and major recurrence, packing density, adverse events related to the procedure and/or device, mortality, initial complete occlusion, aneurysm retreatment, hemorrhage from target aneurysm during follow-up, aneurysm occlusion stability, and clinical outcome at final follow-up. RESULTS A total of 600 patients were randomized (HES, n = 297 and BPC, n = 303), including 28% with ruptured aneurysms. Recurrence occurred in 11 (4.4%) subjects in the HES arm and 44 (15.4%) subjects in the BPC arm (P = .002). While the initial occlusion rate was higher with BPC, the packing density and both major and minor recurrence rates were in favor of HES. Secondary endpoints including adverse events, retreatment, hemorrhage, mortality, and clinical outcome did not differ between arms. CONCLUSION Coiling of small-to-medium aneurysms with second-generation HES resulted in less recurrence when compared to BPC, without increased harm. These data further support the use of the second-generation HES for the embolization of intracranial aneurysms. VIDEO ABSTRACT
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Affiliation(s)
- Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona.,Department of Radiology, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Karl R Abi-Aad
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Jennifer D Ward
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | - Jason F Kniss
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | - Mary J Kwasny
- Department of Preventive Medicine, Feinberg School of Medicine, Chicago, Illinois
| | - Rudy J Rahme
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Najib E El Tecle
- Department of Neurological Surgery, Saint Louis University Hospital, St. Louis, Missouri
| | - Samer G Zammar
- Department of Neurological Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Rami James N Aoun
- Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Devi P Patra
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Sameer A Ansari
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Jean Raymond
- Laboratoire de Neuroradiologie Interventionnelle, Université de Montréal, Montreal, Canada
| | - Henry H Woo
- Department of Neurological Surgery, North Shore University Hospital, Manhasset, New York
| | - David Fiorella
- Department of Radiology, Stony Brook University Hospital, Stony Brook, New York
| | - Guilherme Dabus
- Interventional Neuroradiology and Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Miami, Florida
| | - Genevieve Milot
- Département de Chirurgie, CHU de Quebec, Quebec City, Canada
| | | | - John A Scott
- Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Andrew J DeNardo
- Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Shervin R Dashti
- Department of Neurological Surgery Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky
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10
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Abi-Aad KR, Rahme RJ, Syal A, Patra DP, Hudson M, Richter KR, Ward JD, Knis J, Nak Y, Turcotte E, Welz ME, Winter J, Krishna C, Chong B, Bendok BR. Quality of Life of Patients with Unruptured Intracranial Aneurysms Before and After Endovascular Coiling: A HEAT Trial Secondary Study and Systematic Review of the Literature. World Neurosurg 2020; 146:e492-e500. [PMID: 33127571 DOI: 10.1016/j.wneu.2020.10.120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/21/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND The study of quality of life (QOL) in patients with asymptomatic diseases receiving interventional treatment provides an essential metric for the assessment of procedural benefits in the surgical patient population. In this study, we analyzed QOL data collected from patients with unruptured intracranial aneurysms (UIAs) before and after endovascular coiling in the HEAT Trial, alongside a systematic review on QOL in unruptured brain aneurysms. METHODS HEAT was a randomized controlled trial comparing recurrence rates in aneurysms treated with either bare platinum coils or hydrogel coils. Patients enrolled in this trial completed a short form-36 (SF-36) QOL questionnaire before treatment and at the 3- to 12- and 18- to 24-month follow-ups. The change in QOL before and after treatment was assessed. Regression analysis evaluated the effect of select baseline characteristics on QOL change. RESULTS A total of 270 patients were eligible for analysis. There was an increase in the role physical (P = 0.043), vitality (P = 0.022), and emotional well-being (P < 0.001) QOL components at the 18- to 24-month follow-up compared with baseline scores. Regression analysis showed that age younger than 60 and absence of serious adverse events were associated with improved social functioning and vitality. The literature review showed a mixed effect of intervention on QOL in patients with UIAs. CONCLUSIONS Our analysis has revealed that patients with 3- to 14-mm UIAs had improvements in some physical and emotional components of QOL at 18-24 months following aneurysm coiling in the HEAT study. The literature remains indeterminate on this issue. Further studies are needed to better understand the effects of the diagnosis of UIAs and their treatment on QOL.
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Affiliation(s)
- Karl R Abi-Aad
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Rudy J Rahme
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Arjun Syal
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Devi P Patra
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Miles Hudson
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Kent R Richter
- Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Mayo Clinic Alix School of Medicine, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Jennifer D Ward
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
| | - Jason Knis
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
| | - Yak Nak
- Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Evelyn Turcotte
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Matthew E Welz
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - JoDee Winter
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Chandan Krishna
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Brian Chong
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA; Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA.
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11
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Rahme RJ, Abi-Aad KR, Almekkawi AK, Patra DP, Bendok BR. Endovascular Embolization of a Lateral Sacral Fistula: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E313. [PMID: 32171002 DOI: 10.1093/ons/opaa020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/15/2019] [Indexed: 11/13/2022] Open
Abstract
Spinal dural arteriovenous fistulas are the most common vascular malformations of the spine. They are localized in the sacral spine in 5% to 14% of the cases. They can be fed by the median or the lateral sacral arteries. These lesions present with nonspecific symptoms such as radiculopathy and/or myelopathy, which often leads to a delay in diagnosis. In this video, we present the case of a 65-yr-old gentleman with a lateral sacral dural arteriovenous fistula. The patient was referred to our institution after the outside facility workup was nondiagnostic. He presented with spastic paraparesis and bilateral radiculopathy. After patient informed consent was obtained, we performed a spinal diagnostic angiogram with catheterization and angiography of the internal iliac artery, which revealed the fistula. Onyx (Medtronic, Dublin, Ireland) embolization was performed, which led to a complete occlusion of the fistula. The patient had complete neurological recovery, and at 2-yr follow-up, imaging remained negative for a fistula. In this video, we discuss the nuances and key points related to the epidemiology, diagnosis, and treatment of lateral sacral fistulas.1-3.
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Affiliation(s)
- Rudy J Rahme
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Karl R Abi-Aad
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Ahmad Kareem Almekkawi
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Devi P Patra
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona.,Department of Radiology, Mayo Clinic, Phoenix, Arizona
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12
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Patra DP, Rahme RJ, Zimmerman R, Bendok BR. In Reply: Vascular Transposition of the Superior Cerebellar Artery Using a Fenestrated Clip and Fibrin Glue in Trigeminal Neuralgia: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E98. [PMID: 32294210 DOI: 10.1093/ons/opaa069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/02/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Devi P Patra
- Department of Neurological Surgery Mayo Clinic Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab Mayo Clinic Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab Mayo Clinic Phoenix, Arizona
| | - Rudy J Rahme
- Department of Neurological Surgery Mayo Clinic Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab Mayo Clinic Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab Mayo Clinic Phoenix, Arizona
| | | | - Bernard R Bendok
- Department of Neurological Surgery Mayo Clinic Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab Mayo Clinic Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab Mayo Clinic Phoenix, Arizona.,Department of Otolaryngology Mayo Clinic Phoenix, Arizona.,Department of Radiology Mayo Clinic Phoenix, Arizona
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13
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Syal A, Kalen B, Patra DP, Rahme RJ, Turcotte E, Bendok B. Blood Pressure Management After Embolectomy for Cerebral Large Vessel Occlusion: Toward Evidence-Based Guidelines. World Neurosurg 2020; 138:551-552. [PMID: 32544991 DOI: 10.1016/j.wneu.2020.01.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Arjun Syal
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Brian Kalen
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Devi P Patra
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Rudy J Rahme
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Evelyn Turcotte
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Bernard Bendok
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
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14
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Turcotte EL, Rahme RJ, Merrill SA, Hess RA, Lettieri SC, Bendok BR. The Utility of 5-Aminolevulinic Acid for Microsurgical Resection of Meningiomas. World Neurosurg 2020; 139:343. [PMID: 32272265 DOI: 10.1016/j.wneu.2020.03.178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/25/2020] [Indexed: 11/18/2022]
Abstract
Fluorescence-guided resection of brain tumors using 5-aminolevulinic acid (5-ALA) has been established for high-grade gliomas. Recently, its application for the resection of low grade tumors and benign lesions including meningioma has been suggested in the literature.1 Achieving a Simpson grade I resection in meningioma surgery is associated with a lower rate of recurrence.2,3 Although meningiomas are mostly benign and well-circumscribed lesions, they can be locally aggressive, invading brain parenchyma and other critical structures. In these cases, 5-ALA-guided resection may help maximize the extent of tumor resection and limit disruption of normal structures. In this video, we present 3 cases demonstrating the use of 5-ALA-induced fluorescence to alleviate 3 specific challenges in meningioma resection: 1) to aid visualization with a minimally invasive approach, 2) to distinguish recurrent tumor from scar tissue from prior treatments, and 3) to ensure that no viable tumor cells remain on the surface of a critical artery. The first patient is a 60-year-old woman who was found to have an incidental left sphenoid wing meningioma on magnetic resonance imaging. We elected for an extended lateral orbital craniotomy through a transpalpebral approach. The second patient is a 72-year-old man with recurrent left occipital parietal meningioma who underwent a parietal craniotomy. The third case was a 62-year-old woman with a foramen magnum meningioma encircling the left vertebral artery. These cases demonstrate the utility of 5-ALA in a variety of challenges associated with resection of meningiomas (Video 1).
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Affiliation(s)
- Evelyn L Turcotte
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Rudy J Rahme
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Sarah A Merrill
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Ryan A Hess
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | | | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA; Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona.
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15
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Bendok BR, Abi-Aad KR, Rahme RJ, Turcotte EL, Welz ME, Patra DP, Hess R, Kalen B, Krishna C, Batjer HH. Tulip Giant Aneurysm Amputation and "Shingle Clip Cut Clip" Technique for Microsurgical Reconstruction of a Giant Thrombosed Middle Cerebral Artery Aneurysm. World Neurosurg 2019; 131:166. [PMID: 31377441 DOI: 10.1016/j.wneu.2019.07.192] [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: 04/17/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 11/18/2022]
Abstract
In this video, we present the case of a 61-year-old female who was brought to the emergency department after she had partial complex seizures. Computed tomography and magnetic resonance imaging of the brain revealed a right temporal lobe mass, which was initially thought to be a tumor. The patient was therefore referred to us for further management. The round nature of the lesion raised suspicion for an aneurysm. Computed tomography angiography was performed, followed by a diagnostic conventional cerebral angiogram, and confirmed the presence of a giant thrombosed aneurysm. Giant aneurysms represent 3%-5% of all cerebral aneurysms.1 They are more common in females with a ratio of 2:1 to 3:1.1 They have a high risk of rupture up to 50% in the posterior circulation and 40% in the anterior circulation over 5 years according to the International Study of Unruptured Intracranial Aneurysms Investigators.2,3 Their treatment can be complex and treacherous. Treatment options vary widely from parent artery sacrifice in select cases to clip reconstruction to an array of endovascular approaches such as flow diversion. In some cases a combination of both open and endovascular approaches might be necessary.4-8 In our case, we opted for an open surgical clip reconstruction. A superior temporal artery-middle cerebral artery bypass was attempted to allow for trapping of the aneurysm without risking ischemic complication distal to it. Unfortunately, the patient's vessels were too atherosclerotic to maintain patency. A strategy was then devised, which consisted of cutting the dome of the aneurysm and clearing the distal two thirds of the clot ("tulip technique") and then completing thrombus resection under temporary occlusion. Once clot removal was completed, the aneurysm was clipped using the "shingle clip cut clip" technique (Video 1). The patient's postoperative course was uneventful, and the patient remained seizure free.
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Affiliation(s)
- Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA; Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA.
| | - Karl R Abi-Aad
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA
| | - Rudy J Rahme
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA
| | - Evelyn L Turcotte
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA
| | - Matthew E Welz
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA
| | - Devi P Patra
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA
| | - Ryan Hess
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA
| | - Brian Kalen
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA
| | - Chandan Krishna
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA
| | - Hunt H Batjer
- Department of Neurologic Surgery, University of Texas Southwestern Medical Center, Houston, Texas, USA
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16
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Abi-Aad KR, Aoun RJN, Rahme RJ, Ward JD, Kniss J, Kwasny MJ, Sattur MG, Welz ME, Bendok BR. New generation Hydrogel Endovascular Aneurysm Treatment Trial (HEAT): a study protocol for a multicenter randomized controlled trial. Neuroradiology 2018; 60:1075-1084. [DOI: 10.1007/s00234-018-2074-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
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17
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Sanusi O, Arnaout O, Rahme RJ, Horbinski C, Chandler JP. Surgical Resection and Adjuvant Radiation Therapy in the Treatment of Skull Base Chordomas. World Neurosurg 2018; 115:e13-e21. [PMID: 29545225 DOI: 10.1016/j.wneu.2018.02.127] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Chordomas are rare tumors of notochordal origin that are known to be locally aggressive and are often treated with surgical resection followed by adjuvant radiation therapy (RT). The accepted standard of treatment for chordomas of the mobile spine, which includes en-bloc resection with wide margins, cannot be easily applied to the chordomas of the skull base because of their proximity to critical neurovascular structures. We describe our experience with the role of surgery and adjuvant RT in the treatment of chordomas over 16 years. METHODS We performed a retrospective chart review on patients with diagnoses of clival chordoma between the years 2000 and 2015 at Northwestern Memorial Hospital. We reviewed presenting symptoms, tumor location and size, extent of resection, complications, recurrence, adjuvant treatment, and follow-up duration. RESULTS A total of 20 patients underwent 32 surgeries. Of the 20 initial surgeries, 80% underwent gross total resection, and 20% had subtotal resection. The mean follow-up time was 60.75 months. Mean tumor volume was 23.07 cm3. Most common presenting signs and symptoms were headaches (70%), cranial nerve palsies (45%), and diplopia (55%). Diplopia was defined as complaints of double vision without any objective evidence of a cranial nerve palsy. Median time to progression was 57 months, and median overall survival was 136 months. Initial tumor volume and the need for a second dose of RT either as sole or as adjuvant treatment of a recurrence had a statistically significant effect on progression-free survival (P = 0.009, 0.009). None of the factors studied had a statistically significant effect on overall survival. CONCLUSIONS The treatment of chordomas remain challenging and requires multimodal treatment strategies spanning different specialties. Initial tumor size and need for second dose of RT for recurrence appear to play a significant role in progression-free survival. Adjuvant RT after gross total resection may play a role in improved progression-free and overall survival in patients with clival chordomas.
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Affiliation(s)
- Olabisi Sanusi
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Omar Arnaout
- Brigham and Women's, Harvard School of Medicine, Boston, Massachusetts, USA
| | - Rudy J Rahme
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Craig Horbinski
- Department of Neurological Surgery and Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - James P Chandler
- Department of Neurological Surgery and Otolaryngology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
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Rahme RJ, Arnaout OM, Sanusi OR, Kesavabhotla K, Chandler JP. Endoscopic Approach to Clival Chordomas: The Northwestern Experience. World Neurosurg 2017; 110:e231-e238. [PMID: 29104156 DOI: 10.1016/j.wneu.2017.10.146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Chordomas are rare primary bone tumors with a low-grade histology but an aggressive clinical behavior characterized by local invasion and recurrence. When occurring in the skull base, their treatment is limited by proximity to critical neurovascular structures. Open surgical approaches can carry high morbidity, making the development of alternative approaches desirable. We describe our experience with endoscopic endonasal approaches to clival chordomas over 13 years. METHODS We performed a retrospective chart review of patients diagnosed with clival chordomas and treated with an endoscopic endonasal approach between 2003 and 2015 at Northwestern Memorial Hospital. We reviewed presenting symptoms, tumor location and size, extent of resection, complications, recurrence, adjuvant treatment, retreatment, and follow-up duration. RESULTS A total of 23 charts were reviewed, with 17 included in our final review. Mean age was approximately 48 years. The most common presenting symptom was diplopia present in 70.6% of patients. Mean tumor volume was 20.2 cm3. Gross total resection was achieved in 52.9% of patients. With a mean follow-up period of 63.4 months, 5 patients had a recurrence. The most common complication was cerebrospinal fluid (CSF) leak, which was noted in 6 patients. Tumor volume was significantly higher in patients with CSF leak. No correlation between intradural extension and postoperative CSF leak was noted. CONCLUSIONS Clival chordoma are challenging entities to treat. The best outcomes are achieved with gross total resection followed by adjuvant radiotherapy treatment. We show that the endonasal endoscopic corridor is a viable alternative approach to these lesions.
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Affiliation(s)
- Rudy J Rahme
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois, USA
| | - Omar M Arnaout
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois, USA; Department of Neurological Surgery, Brigham and Women's Hospital, Harvard School of Medicine, Boston, Massachusetts, USA
| | - Olabisi R Sanusi
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois, USA
| | - Kartik Kesavabhotla
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois, USA
| | - James P Chandler
- Departments of Neurological Surgery, Otolaryngology, and Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
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Gupta A, Rahme RJ, Welz ME, Bendok BR. Can Electroencephalogram Detect Vasospasm Before We Do? Neurosurgery 2017; 80:N22-N23. [PMID: 28586484 DOI: 10.1093/neuros/nyx097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aman Gupta
- Department of Neurological Surgery Mayo Clinic Phoenix, Arizona
| | - Rudy J Rahme
- Department of Neurological Surgery Northwestern Medicine and McGaw Medical Center Chicago, Illinois
| | - Matthew E Welz
- Department of Neurological Surgery Mayo Clinic Phoenix, Arizona
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Rahme RJ, Bendok BR. Is Intravenous Tissue Plasminogen Activator Still Relevant for Mechanical Embolectomy Stroke Candidates? World Neurosurg 2016; 98:833-834. [PMID: 28024973 DOI: 10.1016/j.wneu.2016.12.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rudy J Rahme
- Department of Neurological Surgery, Northwestern Medicine and McGaw Medical Center, Chicago, Illinois, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Otolaryngology, and Radiology, Mayo Clinic, Phoenix, Arizona, USA
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Rahme RJ, Aoun RJN, Pines AR, Swanson KR, Bendok BR. Defining the Immune Phenotype for Glioblastoma Multiforme: One Step Closer to Understanding Our Enemy. World Neurosurg 2016; 95:576-577. [DOI: 10.1016/j.wneu.2016.08.063] [Citation(s) in RCA: 1] [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: 01/23/2023]
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Rahme RJ, Pines AR, Krishna C, Bendok BR. Understanding Rupture Risk Factors for Intracranial Aneurysms: Which Ticking Time Bomb Needs to be Defused? Neurosurgery 2016; 79:N11-2. [PMID: 27635966 DOI: 10.1227/01.neu.0000499704.12972.1c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Rudy J Rahme
- *Department of Neurological Surgery, Northwestern Memorial Hospital and McGaw Medical Center, Chicago, Illinois ‡Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona
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Rahme RJ, Pines AR, Welz M, Aoun RJN, Sattur MG, Krishna C, Bendok BR. Improving Neurosurgical Outcomes in the Intensive Care Unit: Could Dexmedetomidine Make a Difference in Ventilator Free Days, Neurological Monitoring, and Outcomes? World Neurosurg 2016; 94:556-558. [PMID: 27476693 DOI: 10.1016/j.wneu.2016.07.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rudy J Rahme
- Department of Neurological Surgery, Northwestern Memorial Hospital and McGaw Medical Center, Chicago, Illinois, USA
| | - Andrew R Pines
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Matthew Welz
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Rami James N Aoun
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Mithun G Sattur
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Chandan Krishna
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
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Arnaout OM, El Ahmadieh TY, Zammar SG, El Tecle NE, Hamade YJ, Aoun RJN, Aoun SG, Rahme RJ, Eddleman CS, Barrow DL, Batjer HH, Bendok BR. Microsurgical Treatment of Previously Coiled Intracranial Aneurysms: Systematic Review of the Literature. World Neurosurg 2015; 84:246-53. [PMID: 25731797 DOI: 10.1016/j.wneu.2015.02.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess indications, complications, clinical outcomes, and technical nuances of microsurgical treatment of previously coiled intracranial aneurysms. METHODS A systematic review of the literature was performed using PubMed/MEDLINE and EMBASE databases from January 1990 to December 2013. English-language articles reporting on microsurgical treatment of previously coiled intracranial aneurysms were included. Articles that involved embolization materials other than coils were excluded. Data on aneurysm characteristics, indications for surgery, techniques, complications, angiographic obliteration rates, and clinical outcomes were collected. RESULTS The literature review identified 29 articles reporting on microsurgical clipping of 375 previously coiled aneurysms. Of the aneurysms, 68% were small (<10 mm). Indications for clipping included the presence of a neck remnant (48%) and new aneurysmal growth (45%). Rebleeding before clipping was reported in 6% of cases. Coil extraction was performed in 13% of cases. The median time from initial coiling to clipping was 7 months. The angiographic cure rate was 93%, with morbidity and mortality of 9.8% and 3.6%, respectively. CONCLUSIONS Microsurgical clipping of previously coiled aneurysms can result in high obliteration rates with relatively low morbidity and mortality in select cases. Considerations for microsurgical strategies include the presence of sufficient aneurysmal tissue for clip placement and the potential need for temporary occlusion or flow arrest. Coil extraction is not needed in most cases.
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Affiliation(s)
- Omar M Arnaout
- Department of Neurological Surgery, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Samer G Zammar
- Department of Neurological Surgery, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Najib E El Tecle
- Department of Neurological Surgery, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Youssef J Hamade
- Department of Neurological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Rami James N Aoun
- Department of Neurological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rudy J Rahme
- Department of Neurological Surgery, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Christopher S Eddleman
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daniel L Barrow
- Department of Neurological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA; Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - H Hunt Batjer
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA.
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Bendok BR, Rahme RJ, Aoun SG, El Ahmadieh TY, El Tecle NE, Batjer HH, Fishman AJ. Enhancement of the subtemporal approach by partial posterosuperior petrosectomy with hearing preservation. Neurosurgery 2014; 10 Suppl 2:191-9; discussion 199. [PMID: 24476903 DOI: 10.1227/neu.0000000000000300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The microsurgical management of aneurysms in the interpeduncular and ambient cisterns remains challenging. The classic subtemporal approach has several limitations. OBJECTIVE To present a modification of this approach that allows for broader exposure with hearing preservation. METHODS We retrospectively reviewed our clinical database between August 2007 and February 2012 for all patients who underwent a modified subtemporal partial posterosuperior petrosectomy. Clinical data, complications, and postoperative head computed tomography (CT) scans were analyzed. Improvement in the angle of view acquired by the new approach was measured using the OsiriX 3-D rendering software and was compared with that obtained from the subtemporal approach. Similar methods were used to study improvement in the angle of view in head CT scans of randomly selected control patients. RESULTS Five patients underwent a modified subtemporal approach for posterior circulation aneurysm clipping. All patients were women with a mean age of 49.8 years. Mean aneurysm size was 5.75 mm. Mean improvement in the angle of view was 17.52° in the study group (n = 5) and 11.7° in the control group (n = 10). Hearing was completely preserved in 3 patients. One patient had a subclinical conductive hearing loss, and 1 patient was not assessed formally at follow-up, but had no hearing concerns. No neurological sequelae were recorded. CONCLUSION Our modified subtemporal approach appears to be safe and provides an increased angle of view with minimal additional operative time and with low risk to hearing. This approach may expand this surgical corridor and reduce the need for temporal lobe retraction.
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Affiliation(s)
- Bernard R Bendok
- *Department of Neurological Surgery, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois; ‡Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; §Department of Otology-Neurotology and Cranial Base Surgery, Cadence Neuroscience Institute at Central DuPage Hospital, Winfield, Illinois
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Rahme RJ, Aoun SG, McClendon J, El Ahmadieh TY, Bendok BR. Spontaneous Cervical and Cerebral Arterial Dissections. Neuroimaging Clin N Am 2013; 23:661-71. [DOI: 10.1016/j.nic.2013.03.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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El Ahmadieh TY, Aoun SG, Daou MR, El Tecle NE, Rahme RJ, Graham RB, Adel JG, Hunt Batjer H, Bendok BR. New-generation oral anticoagulants for the prevention of stroke: Implications for neurosurgery. J Clin Neurosci 2013; 20:1350-6. [DOI: 10.1016/j.jocn.2013.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/05/2013] [Accepted: 05/26/2013] [Indexed: 11/16/2022]
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Markl M, Wu C, Hurley MC, Ansari SA, Carroll TJ, Rahme RJ, Aoun SG, Carr J, Batjer H, Bendok BR. Cerebral arteriovenous malformation: complex 3D hemodynamics and 3D blood flow alterations during staged embolization. J Magn Reson Imaging 2013; 38:946-50. [PMID: 24027116 DOI: 10.1002/jmri.24261] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [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: 07/02/2012] [Accepted: 05/16/2013] [Indexed: 12/27/2022] Open
Abstract
Complex hemodynamics in cerebral arteriovenous malformations (AVM) are thought to play a key role in their pathophysiology. We applied 4D flow magnetic resonance imaging (MRI) for the detailed evaluation of AVM function at baseline and to investigate the impact of staged embolization on AVM hemodynamics in a patient with a Spetzler-Martin grade III AVM. The patient underwent three embolization procedures resulting in >50% nidal casting and obliteration of several arteriovenous fistulae. 4D flow MRI demonstrated highly complex 3D hemodynamics at baseline and revealed intricate arterial feeding, a large vascularized nidus with high variability in regional blood flow velocities, and clearly visible venous drainage with high flow velocities above 50 cm/s. 3D blood flow visualization and quantification during follow-up illustrated the systemic impact of focal embolization on cerebral hemodynamics resulting in compaction of the AVM, redistribution of blood flow velocities, and altered peak flow velocities and blood flow in multiple vascular territories. 4D flow MRI may offer a useful noninvasive tool to help to identify subtleties and nuances of the quantitative hemodynamic alterations in AVM vascular architecture as a supplement to established imaging modalities.
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Affiliation(s)
- Michael Markl
- Departments of Radiology and Biomedical Engineering, Northwestern University, Chicago, Illinois, USA
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Arnaout OM, Rahme RJ, Aoun SG, Daou MR, Batjer HH, Bendok BR. De novo large fusiform posterior circulation intracranial aneurysm presenting with subarachnoid hemorrhage 7 years after therapeutic internal carotid artery occlusion: case report and review of the literature. Neurosurgery 2013; 71:E764-71. [PMID: 22710380 DOI: 10.1227/neu.0b013e31825fd169] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Although the use of proximal artery occlusion, or hunterian ligation, for the treatment of intracranial aneurysms has decreased greatly over the past decades, this approach still finds use for certain giant and complex aneurysms. The main risks of artery sacrifice are ischemic complications but also, although rare, de novo aneurysm formation. We present here a case of de novo formation of a large fusiform basilar artery aneurysm 7 years after internal carotid artery occlusion. CLINICAL PRESENTATION A 17-year-old male patient with a history of a giant right cavernous aneurysm treated 7 years earlier with right-sided endovascular internal carotid artery occlusion presented to our institution with a thunderclap headache. At the time of initial evaluation, the patient was neurologically intact and imaging revealed a 22 × 10-mm fusiform aneurysm of the distal basilar artery with mass effect on the adjacent pons as well as a small amount of subarachnoid and intraventricular blood. Complete occlusion of the right internal carotid artery was demonstrated with retrograde filling of the right middle cerebral artery from the enlarged right posterior communicating artery. The patient was subsequently treated with hunterian occlusion of the basilar artery below anterior inferior cerebellar arteries. A superficial temporal artery to middle cerebral artery bypass was performed on the right side before this occlusion. CONCLUSION Further studies on the epidemiology of de novo aneurysms after carotid artery occlusion are warranted. Patients at higher risk of the development of intracranial aneurysms should be followed aggressively after hunterian ligation, and the possibility of an extracranial-intracranial bypass should be discussed.
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Affiliation(s)
- Omar M Arnaout
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
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Rahme RJ, Fishman AJ, Batjer HH, Bendok BR. In Reply. Neurosurgery 2012. [DOI: 10.1227/neu.0b013e3182672b03] [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: 11/19/2022] Open
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Batjer HH, Aoun SG, Rahme RJ, Bendok BR. Overcoming a bad outcome: thoughts from a colleague. Neurosurgery 2012; 59:34-43. [PMID: 22960511 DOI: 10.1227/neu.0b013e3182698a1a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Conley DB, Tan B, Bendok BR, Batjer HH, Chandra R, Sidle D, Rahme RJ, Adel JG, Fishman AJ. Comparison of Intraoperative Portable CT Scanners in Skull Base and Endoscopic Sinus Surgery: Single Center Case Series. Skull Base 2012; 21:261-70. [PMID: 22470270 DOI: 10.1055/s-0031-1280681] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Precise and safe management of complex skull base lesions can be enhanced by intraoperative computed tomography (CT) scanning. Surgery in these areas requires real-time feedback of anatomic landmarks. Several portable CT scanners are currently available. We present a comparison of our clinical experience with three portable scanners in skull base and craniofacial surgery. We present clinical case series and the participants were from the Northwestern Memorial Hospital. Three scanners are studied: one conventional multidetector CT (MDCT), two digital flat panel cone-beam CT (CBCT) devices. Technical considerations, ease of use, image characteristics, and integration with image guidance are presented for each device. All three scanners provide good quality images. Intraoperative scanning can be used to update the image guidance system in real time. The conventional MDCT is unique in its ability to resolve soft tissue. The flat panel CBCT scanners generally emit lower levels of radiation and have less metal artifact effect. In this series, intraoperative CT scanning was technically feasible and deemed useful in surgical decision-making in 75% of patients. Intraoperative portable CT scanning has significant utility in complex skull base surgery. This technology informs the surgeon of the precise extent of dissection and updates intraoperative stereotactic navigation.
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Day JS, Hurley MC, Chmayssani M, Rahme RJ, Alberts MJ, Bernstein RA, Dabus G, Shaibani A, Bendok BR. Endovascular stroke therapy: a single-center retrospective review. Neurosurg Focus 2012; 30:E10. [PMID: 21631211 DOI: 10.3171/2011.3.focus10267] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Endovascular treatment of acute ischemic stroke delivers direct therapy at the site of an occluded cerebral artery and can be employed beyond the 3-4.5-hour window limit set for intravenous recombinant tissue plasminogen activator. In this paper, the authors report their experience with various endovascular therapies in acute ischemic stroke. METHODS The authors conducted a retrospective review of their clinical database for acute ischemic stroke in large-vessel cerebral territories that underwent endovascular treatment between May 2005 and February 2009. Endovascular treatment was defined as pharmacological and/or mechanical intervention, angioplasty, stenting, or a combination of these methods. Admission National Institutes of Health Stroke Scale and the modified Rankin Scale scores were recorded. Thrombolysis in Myocardial Infarction (TIMI) scores of 0, 1, 2A, 2B, and 3 were used to define recanalization. RESULTS Forty procedures were performed in 39 patients, with 1 patient having sequential bilateral strokes. Nine patients were lost to follow-up after discharge. Strokes in the carotid artery circulation occurred in 82.5% of cases, and those in the vertebral-basilar territory occurred in 17.5%. The Merci device was used in 22 (55%) of 40 procedures, and the Penumbra device in 9 (22.5%) of 40. Angioplasty was performed in 15 (37.5%) of 40 procedures, and intraarterial recombinant tissue plasminogen activator was administered in 23 (57.5%) of 40 procedures. In 23 (57.5%) of 40 cases, multiple recanalization methods were used. The recanalization rate for all methods was 60%. The recanalization rate from TIMI Score 0/1 occlusions was 71.4% (20 of 28). An estimated modified Rankin Scale score of ≤ 2 was obtained in 11 (36.7%) of 30 cases. The overall mortality rate was 26.7% (8 of 30). Intracerebral hemorrhage at 24 hours postprocedure was noted in 17 (42.5%) of 40 cases, 3 (7.5%) of which were symptomatic. CONCLUSIONS The authors' institution performs endovascular stroke treatment with a safety and efficacy profile comparable to those of other major endovascular stroke therapy studies. Recanalization was associated with an improved clinical outcome. Protocols to maximize efficient triage of patients and better documentation of stroke treatments can assist in further studies.
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Affiliation(s)
- Jason S Day
- Department of Neurology, St. Joseph Neurology Associates, Kansas City, Missouri, USA
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Weinberg DG, Rahme RJ, Aoun SG, Batjer HH, Bendok BR. Moyamoya disease: functional and neurocognitive outcomes in the pediatric and adult populations. Neurosurg Focus 2012; 30:E21. [PMID: 21631223 DOI: 10.3171/2011.3.focus1150] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Moyamoya disease is an occlusive cerebrovascular disorder commonly resulting in neurocognitive impairment. The cognitive outcome parameters commonly affected are intelligence, memory, executive function, and quality of life. In this paper, the authors review the existing literature on cognitive and clinical outcomes in adult and pediatric moyamoya populations separately. METHODS A systematic review of the cognitive and clinical outcome literature was performed using the PubMed/MEDLINE database. Outcomes data were contrasted between adult and pediatric populations. RESULTS Intelligence is the main cognitive outcome parameter affected in pediatric patients with moyamoya disease, whereas adults most commonly suffer from executive function impairment. Memory has not been studied sufficiently in pediatric patients, and its dysfunction in the adult population remains controversial. Quality of life has not been studied appropriately in either population. Surgical revascularization is the only beneficial treatment option, and a combination of direct and indirect bypass techniques has shown benefit, but the impact on the above-mentioned parameters has not been sufficiently elucidated. CONCLUSIONS Moyamoya disease affects the cognition and daily function in pediatric patients to a greater extent than in adult patients. Due to the rarity of the disease, there is a distinct lack of high-level evidence regarding cognitive and clinical outcomes.
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Affiliation(s)
- David G Weinberg
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
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Graham RB, Sugrue PA, Rahme RJ, Batjer HH, Bendok BR. Pharyngo-occipital artery variant arising from the internal carotid artery impacting surgical technique during carotid endarterectomy. J Neurointerv Surg 2012; 5:e14. [DOI: 10.1136/neurintsurg-2011-010215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Arnaout OM, Rahme RJ, El Ahmadieh TY, Aoun SG, Batjer HH, Bendok BR. Past, Present, and Future Perspectives on the Endovascular Treatment of Acute Ischemic Stroke. Tech Vasc Interv Radiol 2012; 15:87-92. [DOI: 10.1053/j.tvir.2011.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hurley MC, Rahme RJ, Fishman AJ, Batjer HH, Bendok BR. Combined surgical and endovascular access of the superficial middle cerebral vein to occlude a high-grade cavernous dural arteriovenous fistula: case report. Neurosurgery 2012; 69:E475-81; discussion E481-2. [PMID: 21792142 DOI: 10.1227/neu.0b013e3182192478] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND IMPORTANCE High-grade cavernous sinus (CS) dural arteriovenous fistulae with cortical venous drainage often have a malignant presentation requiring urgent treatment. In the absence of a venous access to the lesion, transarterial embolization can potentially cure these lesions; however, the high concentration of eloquent arterial territories adjacent to the fistula creates a precarious risk of arterial-arterial reflux. In such cases, a combined surgical and endovascular approach may provide the least invasive option. CLINICAL PRESENTATION We describe a patient presenting with a venous hemorrhagic infarct caused by a high-grade CS dural arteriovenous fistula (Barrow type D caroticocavernous fistula) with isolated drainage via the superficial middle cerebral vein into engorged perisylvian cortical veins. No transfemoral or ophthalmic strategy was angiographically apparent, and the posterior location of the involved CS compartment mitigated a direct puncture. The patient underwent direct puncture of the superficial middle cerebral vein via an orbitozygomatic craniotomy and the CS was catheterized under fluoroscopic guidance. The CS was coil-embolized back into the distal superficial middle cerebral vein with complete obliteration of the fistula. The patient did well with no new deficits and made an uneventful recovery. CONCLUSION This novel combined open surgical and endovascular approach enables obliteration of a CS dural arteriovenous fistula with isolated cortical venous drainage and avoids the additional manipulation with direct dissection and puncture of the CS itself.
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Affiliation(s)
- Michael C Hurley
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
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Bendok BR, Rahme RJ. Complex shaped detachable platinum coil system for the treatment of cerebral aneurysms: The Codman Trufill DCS and Trufill DCS Orbit Detachable Coil System COMPLEX Registry final results. J Neurointerv Surg 2011; 5:54-61. [DOI: 10.1136/neurintsurg-2011-010118] [Citation(s) in RCA: 5] [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: 11/03/2022]
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Bendok BR, Gupta DK, Rahme RJ, Eddleman CS, Adel JG, Sherma AK, Surdell DL, Bebawy JF, Koht A, Batjer HH. Adenosine for Temporary Flow Arrest During Intracranial Aneurysm Surgery: A Single-Center Retrospective Review. Neurosurgery 2011; 69:815-821. [DOI: 10.1227/neu.0b013e318226632c] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Weinberg DG, Arnaout OM, Rahme RJ, Aoun SG, Batjer HH, Bendok BR. Moyamoya disease: a review of histopathology, biochemistry, and genetics. Neurosurg Focus 2011; 30:E20. [DOI: 10.3171/2011.3.focus1151] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [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
Object
Moyamoya disease (MMD) is a rare cerebrovascular disorder involving stenosis of the major vessels of the circle of Willis and proximal portions of its principal branches. Despite concerted investigation, the pathophysiology of the disorder has not been fully elucidated. Currently, the major proteins believed to play an active role in the pathogenesis include vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), hepatocyte growth factor (HGF), transforming growth factor–β1 (TGFβ1), and granulocyte colony-stimulating factor (G-CSF). In terms of the genetics, recent literature suggests a low penetrance autosomal dominant or polygenic mode of transmission involving chromosomes 3, 6, 8, 12, and 17 for familial MMD. This review summarizes the current knowledge on the histopathology, pathophysiology and genetics of MMD.
Methods
A PubMed/Medline systematic study of the literature was performed, from which 45 articles regarding MMD pathophysiology were identified and analyzed.
Conclusions
Moyamoya disease is characterized by the intimal thickening and media attenuation of the proximal vessels of the circle of Willis as well as the development of an aberrant distal vascular network. The primary proteins that are currently implicated in the pathophysiology of MMD include VEGF, bFGF, HGF, TGFβ1, and G-CSF. Furthermore, the current literature on familial MMD has pointed to a low penetrance autosomal dominant or polygenic mode of transmittance at loci on chromosomes 3, 6, 8, 12, and 17.
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Pham MH, Rahme RJ, Arnaout O, Hurley MC, Bernstein RA, Batjer HH, Bendok BR. Endovascular Stenting of Extracranial Carotid and Vertebral Artery Dissections: A Systematic Review of the Literature. Neurosurgery 2011; 68:856-66; discussion 866. [DOI: 10.1227/neu.0b013e318209ce03] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Abstract
BACKGROUND:
Carotid and vertebral artery dissections are a leading cause of stroke in young individuals.
OBJECTIVE:
To examine the published safety and efficacy of endovascular stenting for extracranial artery dissection.
METHODS:
We conducted a systematic review of the literature to identify all cases of endovascular management of extracranial carotid and vertebral artery dissections.
RESULTS:
For carotid dissections, our review yielded 31 published reports including 140 patients (153 vessels). Reported etiologies were traumatic (48%, n = 64), spontaneous (37%, n = 49), and iatrogenic (16%, n = 21). The technical success rate of stenting was 99%, and the procedural complication rate was 1.3%. Mean angiographic follow-up was 12.8 months (range, 2-72 months) and revealed in-stent stenosis or occlusion in 2% of patients. Mean clinical follow-up was 17.7 months (range, 1-72 months), and neurological events were seen in 1.4% of patients. For vertebral artery dissections, our review revealed 8 reports including 10 patients (12 vessels). Etiologies were traumatic (60%, n = 6), spontaneous (20%, n = 2), and iatrogenic (20%, n = 2). There was a 100% technical success rate. The mean angiographic follow-up period was 7.5 months (range, 2-12 months). No new neurological events were reported during a mean clinical follow-up period of 26.4 months (range, 3-55 months).
CONCLUSION:
Endovascular management of extracranial arterial dissection continues to evolve. Current experience shows that this treatment option is safe and technically feasible. Prospective randomized trials compared with medical management are needed to further elucidate the role of stenting.
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Affiliation(s)
- Martin H. Pham
- Departments of *Neurological Surgery, ‡Radiology, and §Neurology, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois
| | - Rudy J. Rahme
- Departments of *Neurological Surgery, ‡Radiology, and §Neurology, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois
| | - Omar Arnaout
- Departments of *Neurological Surgery, ‡Radiology, and §Neurology, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois
| | - Michael C. Hurley
- Departments of *Neurological Surgery, ‡Radiology, and §Neurology, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois
| | - Richard A. Bernstein
- Departments of *Neurological Surgery, ‡Radiology, and §Neurology, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois
| | - H. Hunt Batjer
- Departments of *Neurological Surgery, ‡Radiology, and §Neurology, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois
| | - Bernard R. Bendok
- Departments of *Neurological Surgery, ‡Radiology, and §Neurology, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois
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