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Moughal S, Islim FI, Nejadhamzeeigilani H, Saleem N, Goddard T, Patankar T. A large UK single-centre experience in the long-term safety and efficacy of Woven Endobridge in the treatment of wide-neck intracranial aneurysms and risk factors associated with re-bleeding and re-treatment. Interv Neuroradiol 2024:15910199241236818. [PMID: 38613373 DOI: 10.1177/15910199241236818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Endovascular treatment of wide neck aneurysms remains complicated with a determined and continuous technological effort towards treatment options that can offer safer and efficacious outcomes. The Woven Endobridge device was introduced in 2010 and has become a mainstay endovascular treatment for wide neck and large intracranial aneurysms. A recent review of the Woven Endobridge Clinical Assessment of Intrasaccular Aneurysm Therapy (WEBCAST) and WEBCAST2 trials and the five-year follow-up of patients was published. Our aim is to demonstrate real-life experience of aneurysms and patients treated with Woven Endobridge from a large high-volume specialist centre. METHODS A retrospective review was performed of patients treated with Woven Endobridge from March 2013 to March 2018. Primary efficacy outcomes were defined as per Raymond-Roy Occlusion Criteria (RROC) resulting in long-term complete occlusion (RROC1) and adequate occlusion (RROC1 and RROC2). Primary Safety outcomes were defined as procedure-related morbidity, rate of re-bleeding and rate of re-treatment. RESULTS Seventy-nine aneurysms were treated during the five-year period. Adequate aneurysm occlusion (RROC1 and RROC2) achieved was 81%. Retreatment was required in 18% of patients (14/79). Greater retreatment rate was demonstrated in partially thrombosed aneurysms, aneurysms with larger neck and dome diameter and dome heights. CONCLUSION Woven Endobridge treatment of wide-neck intracranial aneurysms offers a safe and efficacious outcome. This large UK single-centre experience demonstrates congruity with recent five-year outcomes of WEBCAST and WEBCAST2 trials.
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Affiliation(s)
- Saad Moughal
- Department of Interventional Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Fathallah Ismail Islim
- Department of Interventional Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | | | - Nayyar Saleem
- Department of Interventional Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Tony Goddard
- Department of Interventional Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Tufail Patankar
- Department of Interventional Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
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Moughal S, Booth TC. Correspondence on 'Non-ischemic cerebral enhancing (NICE) lesions after flow diversion for intracranial aneurysms: a multicenter study' by Richter et al. J Neurointerv Surg 2024:jnis-2024-021548. [PMID: 38388481 DOI: 10.1136/jnis-2024-021548] [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: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Saad Moughal
- Department of Radiology, Manchester Royal Infirmary, Manchester, UK
| | - Thomas C Booth
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
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Shaikh ST, Moughal S, Wael M, Nix P, Tyagi A, Phillips N, Sheikh A. Natural history of post-operative non-functioning pituitary adenomas - a single centre cohort analysis. Br J Neurosurg 2023:1-6. [PMID: 37997810 DOI: 10.1080/02688697.2023.2284789] [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: 07/31/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE To study behaviour of endonasally operated non-functioning pituitary adenomas (NFPA) and propose a cost-effective stratified follow-up regimen. METHODS A single centre retrospective cohort analysis from June 2009 till December 2019. All endonasally operated pituitary adenomas were identified with sub-analysis of the NFPA's. Patients of all age groups with radiological follow-up more than 30 months were included. Patients with any kind of cranial intervention performed < within 30 months of surgery were excluded. The post-operative MRI for this cohort was evaluated until either any intervention was performed or until the last follow-up. The maximal tumour diameter in any plane (mm) was measured from the MRI scans. The annual growth rate and the statistical relationship between age, sex, IHC, Ki-67, resection %, residual tumour was calculated. RESULTS Out of 610 pituitary adenomas identified in the dataset, 116 patients met the inclusion criteria. Follow-up period ranged from 30 to 142 months (mean 78.5 months). A strong relationship existed between predicting tumour progression with first post-operative residue size (p = .001). A statistically significant relationship was found to be present between tumour growth and a residue of less than 10 mm diameter and 11-20 mm in diameter (Log rank p value .0216). On average, each patient with a residue < 5mm had MRI scans costing 976 £. CONCLUSION Based on statistical analysis and internal validation of the growth rate of the residue, we have proposed MRI follow-up scans. These recommendations have the potential to save more than 300 £per patient towards MRI costs and can lay down a marker for defining time interval of serial scans for post-operative NFPA's.
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Affiliation(s)
- Salman T Shaikh
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Saad Moughal
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Mohamed Wael
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Paul Nix
- Department of ENT, Leeds General Infirmary, Leeds, UK
| | - Atul Tyagi
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Nick Phillips
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Asim Sheikh
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
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Moughal S, Christou A, Edwards M, Coebergh J. Looking for inconsistency: Combining distraction with spirography for diagnosis of functional tremor. J Neurol Sci 2023; 453:120785. [PMID: 37703705 DOI: 10.1016/j.jns.2023.120785] [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: 07/09/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Saad Moughal
- St George's Hospitals NHS Foundation Trust, London, UK
| | | | - Mark Edwards
- St George's Hospitals NHS Foundation Trust, London, UK; University of St George's, London, UK
| | - Jan Coebergh
- St George's Hospitals NHS Foundation Trust, London, UK; University of St George's, London, UK; Ashford St Peter's NHS Foundation Trust, Chertsey, UK.
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Moughal S, Elmetwally A, Bashir M, Al-Khaffaf H. Ischaemic monomelic neuropathy of the lower limb. J Vasc Access 2023:11297298231160577. [PMID: 37354031 DOI: 10.1177/11297298231160577] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Abstract
Background: Ischaemic mononeuropathy (IMN) is a rarely reported type of peripheral neuropathy secondary to an ischaemic injury, due to a complication of haemodialysis access. Although underreported, this phenomenon typically occurs in diabetic patients and may reflect the predisposition to neuropathic injury on a background of chronic deleterious changes in the microvasculature in diabetes. It is characterised by mononeuropathic features such as paraesthesia, pain and motor weakness and usually is reported as a rare complication of brachiocephalic fistula. We report a case of IMN which occurred in a patient with end-stage diabetic nephropathy following polytetrafluoroethylene (PTFE) graft placement in the groin as vascular access for haemodialysis.
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Affiliation(s)
- Saad Moughal
- Vascular & Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Ahmed Elmetwally
- Vascular & Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Mohamad Bashir
- Vascular & Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Haytham Al-Khaffaf
- Vascular & Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, UK
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Moughal S, Ahmad S, Saleem N, Derham C. Hypertensive posterior reversible encephalopathy causing obstructive hydrocephalus. Surg Neurol Int 2023; 14:94. [PMID: 37025546 PMCID: PMC10070290 DOI: 10.25259/sni_963_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/03/2023] [Indexed: 03/19/2023] Open
Abstract
Background:
Posterior reversible encephalopathy syndrome (PRES) can occur due to the detrimental effect of malignant hypertension on cerebral autoregulation. Most reported cases describe involvement of the supratentorial areas. Involvement of the posterior fossa structures in conjunction with supratentorial involvement has also been reported; however, PRES affecting the infratentorial structures without supratentorial involvement is a rare phenomenon. Clinical manifestations can involve severe headache, seizures, and reduced consciousness with treatment focused primarily on blood pressure control.
Case Description:
We report a case of PRES with isolated involvement of the infratentorial structures leading to obstructive hydrocephalus. The patient was managed with aggressive control of blood pressure and avoided ventriculostomy or posterior fossa decompression with a good outcome.
Conclusion:
Medical management in the absence of neurological deficit can be associated with a good outcome.
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Affiliation(s)
- Saad Moughal
- Department of Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds,
| | - Sana Ahmad
- Department of Medicine, Pinderfields General Hospital, Wakefield,
| | - Nayyar Saleem
- Department of Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds,
| | - Chris Derham
- Department of Neurosurgery, Leeds General Infirmary, Leeds, United Kingdom
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Ramakrishnan P, Moughal S, Bolton W, Gooden J, Chumas P, Mathew R. SURG-29. CAN NEOADJUVANT CHEMOTHERAPY INCREASE EXTENT OF RESECTION IN DIFFUSE LOWER-GRADE GLIOMA? Neuro Oncol 2022. [PMCID: PMC9660940 DOI: 10.1093/neuonc/noac209.994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
INTRODUCTION
Maximal safe surgical resection remains front-line treatment for diffuse lower-grade gliomas (DLGGs). Greater extent of resection (EOR) can delay transformation, control seizures, and improve survival. EOR is limited by the infiltrative nature of DLGGs and eloquent brain location preponderance. We investigated the role of neoadjuvant chemotherapy in tumour volume reduction (TVR) for cases in which a meaningful EOR was deemed unachievable.
METHODS
Retrospective review (2000-2020) of patients in a large tertiary UK brain tumor centre who serendipitously underwent management that did or could mimic a neoadjuvant chemotherapy pathway. Inclusion criteria: >18 years at diagnosis; histologically-proven WHO grade 2 supratentorial glioma; received chemotherapy alone after biopsy then +/- debulking. Tumour volume delta +/- EOR were calculated on serial MRI T2/FLAIR sequences using a semi-automated quantitative analysis tool (Smartbrush, BrainLab® AG).
RESULTS
Group 1 (neoadjuvant chemotherapy and then surgery, n=4): debulking was considered unachievable initially but then possible post-chemotherapy. Median TVR post-chemotherapy was 16.90% (range 0.45–64.90%). Mean EOR was 68.67% (33.72–100%). Median overall survival (OS) and progression free survival (PFS) were 85 (18–154) and 62 (13–153) months, respectively. Group 2 (biopsy followed by chemotherapy alone, n=7): debulking was considered unachievable initially. Median TVR post-chemotherapy was 25.68% (-294.95–46.02%, one patient progressed during chemotherapy). Median OS and PFS were 92 (6–135) and 27 (3–80) months, respectively. On re-review, and based on Group 1 results, some Group 2 patients may have been able to undergo debulking with meaningful EOR post-chemotherapy.
CONCLUSIONS
Chemotherapy can have a significant impact on reducing tumour volumes, such that cases initially deemed unsuitable for debulking may be converted into those in which a meaningful EOR can be achieved. Larger, multicentre, retrospective studies, and prospective trials are needed to determine the role of chemotherapy as a neoadjuvant tool in the management of DLGGs.
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Affiliation(s)
- Piravin Ramakrishnan
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Saad Moughal
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds , England , United Kingdom
| | - William Bolton
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - John Gooden
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Paul Chumas
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Ryan Mathew
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
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Digby R, Ramakrishnan P, Moughal S, Chakrabarty A, Mathew R. QLTI-19. EVALUATION OF INTRA-OPERATIVE BRAIN TUMOUR DIAGNOSTIC SERVICES – A LARGE TERTIARY UK CENTRE EXPERIENCE. Neuro Oncol 2022. [PMCID: PMC9660885 DOI: 10.1093/neuonc/noac209.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
INTRODUCTION
Brain tumour intraoperative diagnosis (smear cytology, frozen section) is a commonly performed, routine diagnostic service. Currently, samples must be transported from the operating room (OR) to pathology, impacting turnaround time (TAT), carbon emissions (if cross-site), and motivation for repeat sampling. We performed a broad evaluation of current practice in a large, tertiary, UK brain tumour centre, to identify potential gains in real-time tissue diagnosis.
METHODS
All brain tumour samples (n=228) sent for intraoperative diagnosis in 2021 were analysed retrospectively. TAT was assessed by capturing different timepoints along the pathway. Concordance between diagnoses at the following stages was determined: preoperatively based on radiology, intraoperatively (frozen section or smear), provisional paraffin and final integrated. Additionally, we anonymously surveyed neurosurgeons’ opinions (n=18) on the current service.
RESULTS
The mean (±SD) specimen transportation time was 10.6±2.0 minutes, with an estimated total TAT of 30-60 minutes. Intraoperative diagnosis provided a slightly higher rate of concordance with provisional paraffin diagnosis than preoperative radiological diagnosis (89.5% vs 86.3%). Non-concordance was most commonly due to non-representative sampling (e.g., predominantly necrotic), with no repeat sample being sent/available intraoperatively. Prevailing neurosurgical opinion of the intraoperative diagnostic service was dissatisfaction or neutrality (50% and 39% of respondents), with a minority being positive (11%). Reasons for this included: intraoperative delay due to TAT (47%), perceived inaccuracy of results (41%), and perceived reduced out-of-hours availability (56%).
CONCLUSIONS
Current brain tumour intraoperative diagnostic practice relies on physical sample transportation and manual processing; the resultant long TAT causes surgeon dissatisfaction and dissuades repeat analysis in the case of non-representative sampling. Real-time tissue diagnostic technologies such as OR-sited probe-based confocal endomicroscopy, scanners and Raman spectroscopy should be considered to facilitate faster and repeated examination. The latter may have additional benefits in real-time expert pathology feedback, tumour margin-zone analysis and increased extent of resection.
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Affiliation(s)
- Richard Digby
- Department of Histopathology, Leeds Teaching Hospitals NHS Trust, Leeds , England , United Kingdom
| | - Piravin Ramakrishnan
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds , England , United Kingdom
| | - Saad Moughal
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds , England , United Kingdom
| | - Arundhati Chakrabarty
- Department of Histopathology, Leeds Teaching Hospitals NHS Trust, Leeds , England , United Kingdom
| | - Ryan Mathew
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds , England , United Kingdom
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Moughal S, Trippier S, AL-Mousa A, Hainsworth AH, Pereira AC, Minhas PS, Shtaya A. Strokectomy for malignant middle cerebral artery infarction: experience and meta-analysis of current evidence. J Neurol 2022; 269:149-158. [PMID: 33340332 PMCID: PMC8739160 DOI: 10.1007/s00415-020-10358-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/25/2020] [Accepted: 12/04/2020] [Indexed: 11/05/2022]
Abstract
Strokectomy means surgical excision of infarcted brain tissue post-stroke with preservation of skull integrity, distinguishing it from decompressive hemicraniectomy. Both can mitigate malignant middle cerebral artery (MCA) syndrome but evidence regarding strokectomy is sparse. Here, we report our data and meta-analysis of strokectomy compared to hemicraniectomy for malignant MCA infarction. All malignant MCA stroke cases requiring surgical intervention in a large tertiary centre (January 2012-December 2017, N = 24) were analysed for craniotomy diameter, complications, length of follow-up and outcome measured using the modified Rankin score (mRS). Good outcome was defined as mRS 0-3 at 12 months. In a meta-analysis, outcome from strokectomy (pooled from our cohort and published strokectomy studies) was compared with hemicraniectomy (our cohort pooled with published DECIMAL, DESTINY and HAMLET clinical trial data). In our series (N = 24, 12/12 F/M; mean age: 45.83 ± 8.91, range 29-63 years), 4 patients underwent strokectomy (SC) and 20 hemicraniectomy (HC). Among SC patients, craniotomy diameter was smaller, relative to HC patients (86 ± 13.10 mm, 120 ± 4.10 mm, respectively; p = 0.003), complications were less common (25%, 55%) and poor outcomes were less common (25%, 70%). In the pooled data (N = 41 SC, 71 HC), strokectomy tended towards good outcome more than hemicraniectomy (OR 2.2, 95% CI 0.99-4.7; p = 0.051). In conclusion, strokectomy may be non-inferior, lower risk and cost saving relative to hemicraniectomy sufficiently to be worthy of further investigation and maybe a randomised trial.
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Affiliation(s)
- Saad Moughal
- grid.264200.20000 0000 8546 682XNeurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, SW17 0RE UK ,grid.451349.eAtkinson Morley Neurosurgery Centre, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Sarah Trippier
- grid.451349.eNeurology Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Alaa AL-Mousa
- grid.33801.390000 0004 0528 1681Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Atticus H. Hainsworth
- grid.264200.20000 0000 8546 682XNeurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, SW17 0RE UK ,grid.451349.eNeurology Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Anthony C. Pereira
- grid.451349.eNeurology Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Pawanjit S Minhas
- grid.451349.eAtkinson Morley Neurosurgery Centre, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Anan Shtaya
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, SW17 0RE, UK. .,Atkinson Morley Neurosurgery Centre, St George's University Hospitals NHS Foundation Trust, London, UK.
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Moughal S, Uberti M, Al-Mousa A, Al-Dwairy S, Shtaya A, Pereira E. Malignant middle cerebral artery infarction following subacute subdural hematoma: A case report and literature review. Surg Neurol Int 2021; 12:105. [PMID: 33880210 PMCID: PMC8053464 DOI: 10.25259/sni_838_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/18/2021] [Indexed: 11/05/2022] Open
Abstract
Background: Subacute subdural hematomas (ASDH) are only treated surgically when they cause mass effect significant enough to give symptoms. Rarely, sub-ASDH may cause enough pressure to result in a malignant middle cerebral artery (MCA) territory infarction. Decompressive craniectomy (DC) is the last resort to reduce intracranial pressure following malignant MCA infarction. Herein, we review the literature and describe a case of MCA/posterior cerebral artery (PCA) territories infarction following drainage of a sub-ASDH that was treated with DC with good outcome. Case Description: We report a case of malignant right-sided MCA/PCA infarction in a 62-year-old man who presented with progressive headache following a cycling incident leading to a head injury. Initial CT head demonstrated a small right ASDH. He had no neurological deficit, headache settled on analgesia, and there was no expansion of the SDH on the repeat CT; therefore, he was managed conservatively. He was admitted 6-days later with worsening headaches and hyponatremia. Repeat CT revealed an increase in size of the hematoma and mass effect leading to a mini-craniotomy and evacuation of hematoma. He developed left-sided hemiplegia, slurred speech and hyponatremia, and CT head demonstrated a right-sided MCA/PCA infarction with significant mass effect. He underwent emergent DC and subsequent cranioplasty and ultimately recovered to mRS of 2. Conclusion: SDH are frequent neurosurgical entities. Malignant MCA/PCA strokes following mini-craniotomies are rare but need to be considered especially during the consent process.
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Affiliation(s)
- Saad Moughal
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, London, United Kingdom
| | - Micaela Uberti
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, Atkinson Morley Neurosurgery Centre, St George's, University of London, Tooting, London, United Kingdom
| | - Alaa Al-Mousa
- Department of General and Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Salem Al-Dwairy
- Department of General and Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Anan Shtaya
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, Atkinson Morley Neurosurgery Centre, St George's, University of London, Tooting, London, United Kingdom
| | - Erlick Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, Atkinson Morley Neurosurgery Centre, St George's, University of London, Tooting, London, United Kingdom
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Moughal S, Bashir M. Response to "Correlation of intracranial and aortic aneurysms". Asian Cardiovasc Thorac Ann 2020; 28:535-536. [PMID: 32727207 DOI: 10.1177/0218492320947237] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Saad Moughal
- Department of Vascular and Endovascular Surgery, 155510Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Mohamad Bashir
- Department of Vascular and Endovascular Surgery, 155510Royal Blackburn Teaching Hospital, Blackburn, UK
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Abstract
Acute aortic syndrome is a group of interlinked conditions with common presenting symptoms, including aortic dissection, penetrating atherosclerotic ulcer, and intramural hematoma. Pharmacological management of acute aortic syndrome is a growing area, with key themes to address the underlying inflammatory pathways believed to be the cause. Research into interleukins, matrix metalloproteinases, and granulocyte macrophage colony-stimulating factor are just some of the many immunological properties being investigated and translated into medical therapies. Stem cell experiments may indicate further advances in the pathologies of acute aortic syndrome. The study of pharmacogenomics to improve treatment across different genomes is also a novel area outlined in this paper.
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Affiliation(s)
- Lara Jane Rimmer
- Vascular Surgery Department, 155510Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Saad Moughal
- Vascular Surgery Department, 155510Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Mohamad Bashir
- Vascular Surgery Department, 155510Royal Blackburn Teaching Hospital, Blackburn, UK
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Jakob H, Moughal S, Bashir M. Frozen elephant trunk with straight vascular prosthesis: single-center experience with a review of current trends. J Cardiovasc Surg 2020; 61:301-307. [DOI: 10.23736/s0021-9509.20.11401-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
The correlation between intracranial and aortic aneurysms remains elusive. Data in the literature are scattered, and outcome reporting is swamped with heterogeneity and single-center bias. This calamity is adding to confusion on decision-making and delays the instigation of appropriate clinical applications. This literature review delves into the abyss of the lack of clinically driven scientific input, and highlights the trends explored thus far.
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Affiliation(s)
- Saad Moughal
- Department of Vascular and Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Mohamad Bashir
- Department of Vascular and Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, UK
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Hansrani V, Moughal S, Elmetwally A, Al-Khaffaf H. A review into the management of May-Thurner syndrome in adolescents. J Vasc Surg Venous Lymphat Disord 2020; 8:1104-1110. [PMID: 32474151 DOI: 10.1016/j.jvsv.2020.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/07/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate the presentation, etiology, management and outcomes of May-Thurner syndrome (MTS) in adolescents aged under 18. METHODS We searched electronic bibliographic databases to identify published reports of MTS in patients under 18 years of age. We conducted our review according to the PRISMA statement standards. RESULTS Ten studies encompassing 22 patients treated for MTS in adolescent cases were identified. The mean age of patients was 15 years (range, 10-18 years). Of the 22 patients, 12 (55%) were confirmed to have proximal deep vein thrombosis as the primary indication for intervention. Treatment methods included catheter-directed thrombolysis and iliac vein stenting (41%), pharmacomechanical thrombolysis and iliac vein stenting (18%), iliac vein stenting alone (27%), open surgery (14%), catheter-directed thrombolysis (5%), and anticoagulation alone (5%). Complications were infrequent. All studies reported subjective improvements in clinical symptoms with only two studies using validate outcome measures. In total, 9 of 22 patients (41%) had addition risk factors that may precipitate thrombosis. CONCLUSIONS As in adults, the most common form of treatment seen in the literature is a combination of catheter direct thrombolysis, followed by iliac vein stenting with subsequent anticoagulation. Complications from interventions were low. It is unclear how these interventions affect symptomology and the long-term sequalae associated endovascular surgery and stenting in adolescents. Further research is needed in well-designed studies with adequate follow-up.
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Affiliation(s)
- Vivak Hansrani
- Department of Vascular Surgery, Royal Blackburn Hospital, East Lancashire NHS Trust, Blackburn, UK.
| | - Saad Moughal
- Department of Vascular Surgery, Royal Blackburn Hospital, East Lancashire NHS Trust, Blackburn, UK
| | - Ahmed Elmetwally
- Department of Vascular Surgery, Royal Blackburn Hospital, East Lancashire NHS Trust, Blackburn, UK
| | - Haytham Al-Khaffaf
- Department of Vascular Surgery, Royal Blackburn Hospital, East Lancashire NHS Trust, Blackburn, UK
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Affiliation(s)
- Mohamad Bashir
- Department of Vascular and Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, United Kingdom.
| | - Saad Moughal
- Department of Vascular and Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, United Kingdom
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Moughal S, Boeris D, Hainsworth A, Pereira E, Shtaya A, Minhas P. WM1-4 Decompressive craniectomy versus strokectomy for malignant middle cerebral artery (MCA) infarction. J Neurol Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectivesTo compare the outcomes of decompressive craniectomy (DC) with craniotomy and debulikng of stroke tissue (Strokectomy (SC)) for malignant MCA infarction at our centre.DesignRetrospective records review.SubjectsAll Patients with malignant MCA infraction that underwent DC and SC between Jan 2012 and Sep 2017.Methods20 patients had DC (11F/9M, mean age 44.7±1.8 y) and four patients had SC (1F/3M) 51.5±5.9 7 y). Outcomes were assessed by Modified Rankin Scale (mRS) scores before surgery and at latest follow up (3–6 months). mRS was dichotomised as good (0–3) and poor (4–6). Craniotomy size was measured by antero-posterior (AP) diameter and compared between the groups.Results18 patients (90%) of the DC group had mRS 4–6 before surgery versus 100% in the SC group. Post-surgery 15 patients (75%) of the DC group had poor outcome with 7 mortalities (35%) in comparison to one patient (25%) with poor outcome in the SC group and no mortalities. The average craniotomy size in DC was 120.1±4.1 mm versus 85.5±13.1 mm in the SC, p=0.003 students t test). Six patients of the DC group underwent cranioplasty where two developed post-operative seizures. There was no significant difference in age, sex and side of craniotomy (7 Left/13 Right in DC vs 2 Left/2 Right in SC).ConclusionsStrokectomy is comparable to decompressive craniectomy in outcomes without taking the extra risks and costs of cranioplasty. Further studies are required to promote this approach.
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Moughal S, Coebergh JA. 14 Analysis of spiral drawings as a means of exploring differences between functional and essential tremor: an ink and paper approach. J Neurol Psychiatry 2017. [DOI: 10.1136/jnnp-2017-bnpa.38] [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: 11/04/2022]
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