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Lim J, Aguirre AO, Rattani A, Baig AA, Monteiro A, Kuo CC, Siddiqi M, Im J, Housley SB, McPheeters MJ, Ciecierska SSK, Jaikumar V, Vakharia K, Davies JM, Snyder KV, Levy EI, Siddiqui AH. Thrombectomy outcomes for acute ischemic stroke in lower-middle income countries: A systematic review and analysis. World Neurosurg X 2024; 23:100317. [PMID: 38511159 PMCID: PMC10950731 DOI: 10.1016/j.wnsx.2024.100317] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024] Open
Affiliation(s)
- Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Alexander O. Aguirre
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Abbas Rattani
- Department of Radiation Oncology, Tufts University Medical Center, Boston, MA, USA
| | - Ammad A. Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Cathleen C. Kuo
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Manhal Siddiqi
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Justin Im
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Steven B. Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Matthew J. McPheeters
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | | | - Vinay Jaikumar
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Kunal Vakharia
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Jason M. Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
| | - Kenneth V. Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
| | - Elad I. Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Adnan H. Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Cappuzzo JM, Waqas M, Housley SB, Monteiro A, Siddiqui AH, Levy EI. Snare, stent retriever, and aspiration for a prematurely detached coil during treatment of a reruptured anterior communicating artery aneurysm. Interv Neuroradiol 2024; 30:130-131. [PMID: 35953891 PMCID: PMC10956448 DOI: 10.1177/15910199221115612] [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: 04/14/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Advanced salvage techniques are an essential tool in the armamentarium of any experienced endovascular surgeon. In this video, we show a patient presenting with rerupture of an anterior communicating artery (ACoA) aneurysm that had been treated with balloon-assisted coiling several months earlier in a ruptured setting. Premature coil detachment occurred during an attempt to coil a new bleb that the aneurysm had developed, and a sequence of salvage maneuvers was performed. An initial attempt to implant that coil failed, and retrieval with a snare unfortunately caused coil fragmentation and occlusion of the anterior cerebral artery (ACA). Further salvage maneuvers required inducing flow-arrest with a balloon-guide catheter, use of a stent-retriever to recanalize the ACA A2 segment, and aspiration to capture a small fragment of coil that was seen at the tip of the balloon guide catheter.
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Affiliation(s)
- Justin M Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
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Waqas M, Monteiro A, Cappuzzo JM, Kruk MD, Almayman F, Housley SB, Lim J, Dossani RH, Snyder KV, Siddiqui AH, Davies JM, Levy EI. Mechanical thrombectomy with a balloon-guide catheter: sheathless transradial versus transfemoral approach. J Neurointerv Surg 2024; 16:187-191. [PMID: 36581453 DOI: 10.1136/jnis-2022-019607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/08/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The transradial approach (TRA) for mechanical thrombectomy (MT) for acute ischemic stroke has been limited by the size of catheters usable in the radial artery, with the smaller access site precluding balloon-guide catheter (BGC) use. However, promising results have been reported for a TRA with a sheathless BGC (sTRA). We sought to perform a comparative study of MT with a BGC via the sTRA versus the transfemoral approach (TFA). METHODS A retrospective review of our MT database was conducted. Baseline, procedure-related, and outcome data were compared for patients aged ≥18 years with anterior circulation large vessel occlusion, Alberta Stroke Program Early CT Score ≥6, and prestroke modified Rankin Scale score ≤2 treated with either approach. RESULTS Ninety-three consecutive patients (34 sTRA and 59 TFA) were included. Both groups had similar demographics, comorbidities, stroke severity, intravenous alteplase use, and occlusion location. Mean time from puncture to final recanalization was faster in the sTRA group (29 vs 36 min, p=0.059) despite a higher access site crossover rate in the sTRA group (11.8% vs 0%, p=0.016). There were no differences between groups regarding last modified Thombolysis in Cerebral Infarction score; first-pass or modified first-pass effect; time from last known well to puncture; use of stent-retriever, aspiration, or combination first approach; number of passes; symptomatic intracranial hemorrhage; hospital stay; 90-day functional independence; and mortality. National Institutes of Health Scale score and modified first-pass effect were the only independent predictors of poor outcomes. CONCLUSIONS Comparable patients treated with MT via the sTRA or TFA had similar angiographic and clinical outcomes.
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Affiliation(s)
- Muhammad Waqas
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Andre Monteiro
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Marissa D Kruk
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Faisal Almayman
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Steven B Housley
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Jaims Lim
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Rimal H Dossani
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Kenneth V Snyder
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
- Neurosurgery and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Jason M Davies
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
- Neurosurgery and Bioinformatics and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Elad I Levy
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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4
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Aguirre AO, Lim J, Kuo CC, Ruggiero N, Siddiqi M, Monteiro A, Baig AA, Housley SB, Recker MJ, Li V, Reynolds RM. Social Determinants of Health and Associations With Outcomes in Pediatric Patients With Brain Tumors. Neurosurgery 2024; 94:108-116. [PMID: 37526439 DOI: 10.1227/neu.0000000000002624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/25/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Social determinants of health (SDOH) are nonmedical factors that affect health outcomes. Limited investigation has been completed on the potential association of these factors to adverse outcomes in pediatric populations. In this study, the authors aimed to analyze the effects of SDOH disparities and their relationship with outcomes after brain tumor resection or biopsy in children. METHODS The authors retrospectively reviewed the records of their center's pediatric patients with brain tumor. Black race, public insurance, median household income, and distance to hospital were the investigated SDOH factors. Univariate analysis was completed between number of SDOH factors and patient demographics. Multivariate linear regression models were created to identify coassociated determinants and outcomes. RESULTS A total of 272 patients were identified and included in the final analysis. Among these patients, 81 (29.8%) had no SDOH disparities, 103 (37.9%) had 1, 71 (26.1%) had 2, and 17 (6.2%) had 3. An increased number of SDOH disparities was associated with increased percentage of missed appointments ( P = .002) and emergency room visits ( P = .004). Univariate analysis demonstrated increased missed appointments ( P = .01), number of postoperative imaging ( P = .005), and number of emergency room visits ( P = .003). In multivariate analysis, decreased median household income was independently associated with increased length of hospital stay ( P = .02). CONCLUSION The SDOH disparities are prevalent and impactful in this vulnerable population. This study demonstrates the need for a shift in research focus toward identifying the full extent of the impact of these factors on postoperative outcomes in pediatric patients with brain tumor.
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Affiliation(s)
- Alexander O Aguirre
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
| | - Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
| | - Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
| | - Nicco Ruggiero
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
| | - Manhal Siddiqi
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
| | - Ammad A Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
| | - Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
| | - Matthew J Recker
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
| | - Veetai Li
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Pediatric Neurosurgery, John R. Oishei Children's Hospital, Buffalo , New York , USA
| | - Renée M Reynolds
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Pediatric Neurosurgery, John R. Oishei Children's Hospital, Buffalo , New York , USA
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Housley SB, Turner RC, Bouslama M, Lim J, Raygor KP, Lai PMR, Monteiro A, Baig AA, Nyabuto E, Davies JM, Siddiqui AH, Snyder KV, Levy EI. Expansion and Subsequent Rupture of Carotid Pseudoaneurysm After Tandem Carotid and Middle Cerebral Artery Occlusion Treated With Mechanical Thrombectomy and Carotid Stenting. Oper Neurosurg (Hagerstown) 2023; 25:e206-e210. [PMID: 37387562 DOI: 10.1227/ons.0000000000000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/03/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Extracranial carotid artery pseudoaneurysm is a rare entity with potential etiologies including infection, blunt trauma, postsurgical atherosclerotic disease, and invasive neoplasia. Although the natural history of carotid pseudoaneurysm is difficult to determine because of its rarity, complications such as stroke, rupture, and local mass effect may occur at staggering rates. CLINICAL PRESENTATION In this case, a middle-aged man presented with a tandem carotid, middle cerebral artery occlusion that was treated with a carotid stent and mechanical thrombectomy. He returned 3 weeks later with a ruptured carotid pseudoaneurysm that was then treated with a covered stent. He made a full recovery and was neurologically intact on follow-up. CONCLUSION This case illustrates a rare potential complication of carotid occlusion and stenting with possible catastrophic consequences. The goal of this report was to educate other clinicians in remaining vigilant in awareness of this complication and provide a framework for potential treatment if and when it occurs.
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Affiliation(s)
- Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Ryan C Turner
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Mehdi Bouslama
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Kunal P Raygor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Pui Man Rosalind Lai
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Ammad A Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Elizabeth Nyabuto
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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Housley SB, Monteiro A, Khawar WI, Donnelly BM, Lian MX, Fritz AG, Waqas M, Cappuzzo JM, Snyder KV, Siddiqui AH, Levy EI, Davies JM. Volumetric resolution of chronic subdural hematomas treated with surgical evacuation versus middle meningeal artery embolization during immediate, early, and late follow up: propensity-score matched cohorts. J Neurointerv Surg 2023; 15:943-947. [PMID: 36137743 DOI: 10.1136/jnis-2022-019427] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/26/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Literature on volumetric resolution and recurrence over time between surgical evacuation alone (SEA) and standalone middle meningeal artery embolization (MMAE) in comparable chronic subdural hematoma (cSDH) patients is limited. METHODS A retrospective database analysis of cSDH patients managed with either SEA or MMAE was conducted. Propensity-score matching was performed for axial and coronal lengths, maximum diameter, and midline shift. Volumetric measurements at multiple time intervals and recurrence were compared between the groups. RESULTS 48 matched hematoma pairs in patients with similar demographics, comorbidities, medications, and symptoms were obtained. Median volume was significantly lower at 24 hours in the SEA group (12.6 mL vs 52.7 mL, p<0.001) but not at remaining intervals. Median volume reduction was significantly greater in the SEA group at 24 hours (39.1 mL vs 8.8 mL in the MMAE group, p<0.001) and at 3-12 weeks (50.8 mL vs 23.7 mL, p<0.001), but not at remaining intervals. The SEA group had a significantly greater median hematoma resolution rate at 24 hours (39.1 mL/day vs 8.8 mL/day, p<0.001) and 3-12 weeks (1 mL/day vs 0.4 mL/day, p<0.001), but not at remaining intervals. Near-complete resolution at 3-12 weeks and 12-60 weeks was not significantly different between groups. Overall, the recurrence rate was significantly higher in the SEA group (22.9% vs 4.2%, p=0.01). CONCLUSIONS In comparable cSDH patients, SEA resulted in better volumetric outcomes in immediate postoperative and early follow-up periods, as expected. However, this difference was not significant at more distant follow-up intervals. Furthermore, surgical patients experienced a significantly higher rate of recurrence.
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Affiliation(s)
- Steven B Housley
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Andre Monteiro
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Wasiq I Khawar
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Brianna M Donnelly
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Ming Xia Lian
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Alexander G Fritz
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Muhammad Waqas
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Kenneth V Snyder
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Neurosurgery and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Elad I Levy
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Jason M Davies
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Neurosurgery and Bioinformatics and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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7
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Popoola D, Housley SB, Jacoby WT, Lim J, Cappuzzo JM, Levy EI. Non-dermatologic isolated intracranial necrobiotic xanthogranuloma. BMJ Case Rep 2023; 16:e254122. [PMID: 37648279 PMCID: PMC10471863 DOI: 10.1136/bcr-2022-254122] [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] [Indexed: 09/01/2023] Open
Abstract
Necrobiotic xanthogranuloma is a condition that was first identified in 1980 based on its characteristic histological identity, and it has been known since then as a dermatologic manifestation of an underlying systemic dysproteinemia. Intracranial manifestation is a rare presentation of this condition and has been reported only once in its more than 40 years of existence. Herein and to our knowledge, we report the second observation of an intracranial manifestation and, surprisingly, the first case without the expected dermatologic and systemic dysproteinemia associations. This case identifies an existing knowledge gap in our understanding of necrobiotic xanthogranuloma and emphasises the need for further research into understanding the presentation, comorbidities and management of this condition.
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Affiliation(s)
- Daniel Popoola
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Steven B Housley
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Buffalo General Medical Center, Buffalo, New York, USA
| | - Wady T Jacoby
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Jaims Lim
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Buffalo General Medical Center, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Buffalo General Medical Center, Buffalo, New York, USA
| | - Elad I Levy
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
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8
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Monteiro A, Lim J, Siddiqi M, Donnelly BM, Khawar W, Baig A, Turner RC, Bouslama M, Raygor KP, Lai PMR, Housley SB, Davies JM, Snyder KV, Siddiqui AH, Levy EI. The first decade of flow diversion for intracranial aneurysms with the Pipeline embolization device. Neurosurg Focus 2023; 54:E2. [PMID: 37127038 DOI: 10.3171/2023.2.focus22646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 02/13/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Flow diverter devices have revolutionized the treatment of intracranial aneurysms (IAs) since their approval in 2011 and have continued to evolve. The devices have been widely adopted across institutions and centers over the past decade; however, long-term follow-up after treatment with the Pipeline embolization device (PED) is not well described in the literature. The authors' institution was among the first to begin using PEDs, allowing them to report their series of patients treated with flow diverters ≥ 10 years ago. In this study, the authors aimed to evaluate the long-term angiographic and clinical outcomes of these patients and review lessons learned along the way. METHODS The authors performed a retrospective review of their institution's IA database from January 2007 to July 2012. All patients with IAs treated with a PED prior to July 2012 were included. Clinical and angiographic characteristics were extracted. Available angiographic follow-up at 1, 3, 5, and 10 years was reported. RESULTS A total of 83 patients with 92 aneurysms treated with a PED ≥ 10 years ago were identified and included in the study. The mean aneurysm dome diameter was 9.2 (SD 5.7) mm, the mean aneurysm height was 10.4 (SD 6.8) mm, and the mean neck width was 4.1 (SD 2.4) mm. Only 1 (1.1%) aneurysm was ruptured at presentation. Eight (8.7%) aneurysms were recurrences of previous treatment modalities. The morphology was saccular in 77 (83.7%) aneurysms, fusiform in 14 (15.2%), and blister-like in 1 (1.1%). Among saccular aneurysms, 60 (77.9%) were wide-necked. Seventy-five (81.5%) aneurysms were in the internal carotid artery, 12 (13.0%) were vertebrobasilar, 3 (3.3%) were in the middle cerebral artery, and 2 (2.2%) were in the posterior cerebral artery. Angiographic follow-up at 1, 3, 5, and 10 years was available for 75, 59, 50, and 15 patients, respectively. The complete occlusion rates at 1, 3, 5, and 10 years were 94.7%, 96.6%, 96.0%, and 100%, respectively. The retreatment rates at 1, 3, 5, and 10 years were 8.0%, 6.8%, 8.0%, and 6.7%, respectively. CONCLUSIONS The authors provide their single-institution series of IA patients treated with a PED ≥ 10 years ago, with the first report of 10-year follow-up for the available patients.
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Affiliation(s)
- Andre Monteiro
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
| | - Jaims Lim
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
| | - Manhal Siddiqi
- 4Jacobs School of Medicine and Biomedical Sciences, University at Buffalo; and
| | - Brianna M Donnelly
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
| | - Wasiq Khawar
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
| | - Ammad Baig
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
| | - Ryan C Turner
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
| | - Mehdi Bouslama
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
| | - Kunal P Raygor
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
| | - Pui Man Rosalind Lai
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
| | - Steven B Housley
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
| | - Jason M Davies
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
- 3Jacobs Institute, Buffalo
- 5Canon Stroke and Vascular Research Center, University at Buffalo, New York
- 6Radiology, and
- 7Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
| | - Kenneth V Snyder
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
- 3Jacobs Institute, Buffalo
- 5Canon Stroke and Vascular Research Center, University at Buffalo, New York
- 6Radiology, and
- 7Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
| | - Adnan H Siddiqui
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
- 3Jacobs Institute, Buffalo
- 5Canon Stroke and Vascular Research Center, University at Buffalo, New York
- 6Radiology, and
- 7Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
| | - Elad I Levy
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
- 3Jacobs Institute, Buffalo
- 5Canon Stroke and Vascular Research Center, University at Buffalo, New York
- 6Radiology, and
- 7Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
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9
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Housley SB, Monteiro A, Khawar W, Donnelly B, Lian M, Fritz A, Baig A, Waqas M, Cappuzzo JM, Snyder KV, Siddiqui AH, Levy EI, Davies J. 479 Chronic Subdural Hematomas Treated With Surgical Evacuation Versus Standalone Middle Meningeal Artery Embolization: Volumetric Resolution in Immediate, Early and Late Follow-Up in a Propensity Matched Cohort. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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10
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Housley SB, Monteiro A, Cappuzzo JM, Khawar WI, Levy EI. Salvage of Intraoperative Rupture of a Wide-Necked Middle Cerebral Artery Bifurcation Aneurysm: The Felt-Fenestrated Clipping Technique. Oper Neurosurg (Hagerstown) 2023; 24:e57-e60. [PMID: 36637307 DOI: 10.1227/ons.0000000000000462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/09/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Intraoperative aneurysm rupture during microsurgical clipping can be managed with different salvage techniques. In an aneurysm with a very wide neck that is located at a bifurcation, repairing an iatrogenic tear can be challenging and carry the risk of branch occlusion and infarction. OBJECTIVE To describe a variation of the cotton-clipping technique modified to better fit the bifurcation anatomy, which we call "felt-fenestrated clipping." METHODS An illustrative case of intraoperative rupture of a wide-necked middle cerebral artery bifurcation aneurysm is presented. Radiological imaging, operative video, and technique illustration were obtained and prepared for this report. RESULTS A middle-aged woman underwent microsurgical clipping of a wide-necked middle cerebral artery bifurcation aneurysm. A right-angle clip became dislodged from the clip applier and snapped across the aneurysm causing a small rupture at the base. This was later determined to be the result of improper placement of a standard clip onto a mini-clip applier. After a few salvage attempts, a small piece of Teflon felt was placed over the rupture site and held in place using a straight, fenestrated clip. Then, the right-angle clip was applied over the true neck of the aneurysm and the edge of the rupture site, covering the Teflon felt to obtain true hemostasis. CONCLUSION We demonstrate a technically successful felt-fenestrated clipping technique for treatment of an intraoperative rupture not amenable to other salvage options. This technique is useful to achieve hemostasis while preserving branches in wide-necked bifurcation aneurysms.
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Affiliation(s)
- Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Wasiq I Khawar
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA.,Jacobs Institute, Buffalo, New York, USA
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11
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Housley SB, Cappuzzo JM, Waqas M, Lim J, Levy EI. Rescue of inadvertent superior sagittal sinus occlusion during middle meningeal artery embolization. Interv Neuroradiol 2022:15910199221138152. [PMID: 36475955 DOI: 10.1177/15910199221138152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Middle meningeal artery embolization is increasingly becoming popular in the treatment of chronic subdural hematomas. The safety and efficacy of the procedure has previously been demonstrated in the literature; however, complications do arise from time to time. Here we present the case of an elderly gentleman who experienced inadvertent embolization of the superior sagittal sinus through an occult arteriovenous fistula between the middle meningeal artery and the superior sagittal sinus. Multiple rescue techniques including aspiration and stent retriever thrombectomy were performed with restoration of venous flow and an overall optimal result.
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Affiliation(s)
- Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo General Medical Center and 23564Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo General Medical Center and 23564Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo General Medical Center and 23564Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
| | - Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo General Medical Center and 23564Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo General Medical Center and 23564Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
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12
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Housley SB, Cappuzzo JM, Waqas M, Monteiro A, Levy EI, Siddiqui AH. FRED flow diversion with LVIS protection of large posterior communicating artery aneurysm: the "FRELVIS" technique. Neurosurg Focus Video 2022; 7:V4. [PMID: 36425266 PMCID: PMC9664491 DOI: 10.3171/2022.7.focvid2262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/18/2022] [Indexed: 06/16/2023]
Abstract
Treatment of wide-necked posterior communicating artery (PCoA) aneurysms is extremely challenging, especially in fetal posterior cerebral artery (PCA) configurations. This technical video demonstrates the nuances of an innovative use of flow diversion to treat a recurrent wide-necked PCoA aneurysm. This middle-aged patient presented with recurrence of a previously ruptured, coil-embolized PCoA aneurysm. Initial attempts at Comaneci-assisted coiling were unsuccessful because the coil herniated into the middle cerebral artery (MCA). Therefore, a low-profile visualized intraluminal support (LVIS) was placed in the fetal PCA across the aneurysm ostium and a flow diverter was placed in the internal carotid artery and MCA to constitute a Y-construct. The video can be found here: https://stream.cadmore.media/r10.3171/2022.7.FOCVID2262.
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Affiliation(s)
- Steven B. Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo
| | - Justin M. Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo
| | - Elad I. Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
- Canon Stroke and Vascular Research Center, University at Buffalo; and
- Jacobs Institute, Buffalo, New York
| | - Adnan H. Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
- Canon Stroke and Vascular Research Center, University at Buffalo; and
- Jacobs Institute, Buffalo, New York
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13
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Housley SB, Waqas M, Cappuzzo JM, Almayman F, Metcalf-Doetsch W, Siddiqui AH. Transarterial and transvenous pial arteriovenous Fistula embolization: A video case report. Interv Neuroradiol 2022:15910199221122846. [PMID: 36071583 DOI: 10.1177/15910199221122846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cerebral pial arteriovenous fistulas (pAVFs) are rare and complex high-flow vascular malformations found in pediatric and adolescent populations.1 They are often divided into two groups based on the pattern of venous drainage, galenic or nongalenic. Nongalenic pAVFs are typically supratentorial and carry a high risk of rupture. Their angioarchitecture is very complex with various patterns of feeding arteries and draining veins not originating from dural vessels or the vein of Galen.2 The natural history has not been well established; however, mortality estimates range as high 63%.1 Presentations include hemorrhage, seizure, congestive heart failure, and elevated intracranial pressure.3 We describe the case of an adolescent girl with acute onset of headaches that led to the discovery of an occipital, nongalenic pAVF. Transarterial and transvenous embolizations performed during a single procedure resulted in complete obliteration of the fistula. No complications arose, and the patient remained at her neurological baseline.
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Affiliation(s)
- Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Justin M Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Faisal Almayman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - William Metcalf-Doetsch
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
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14
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Fuentes AM, Housley SB, Starling RV, Mullin JP. Extensive Symptomatic Thoracolumbar Epidural Lipomatosis Treated With Minimally Invasive Hemilaminectomies: Technical Case Report. Oper Neurosurg (Hagerstown) 2022; 23:e184-e188. [PMID: 35972109 DOI: 10.1227/ons.0000000000000296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/03/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Spinal epidural lipomatosis is a rare condition commonly associated with chronic corticosteroid use and obesity that involves deposition of adipose tissue in the epidural space of the spinal canal. This accumulation of adipose tissue may cause compression of the spinal cord and/or nerve roots and result in compressive symptoms such as myelopathy or radiculopathy. Spinal involvement is usually confined to either the thoracic or lumbar spine but can infrequently affect both regions. Depending on pre-existing conditions, treatment options include weight loss and discontinuation of exogenous steroid use, both of which have been shown to be effective therapeutic methods. Surgical decompression may be useful for appropriately selected patients in whom conservative therapy has failed or who experience acute neurological deterioration, although this is rarely indicated. CLINICAL PRESENTATION In this study, we describe a patient receiving long-term corticosteroid therapy who presented with symptomatic epidural lipomatosis that involved the thoracic and lumbar spine. She was treated with decompression by continuous T3-L5 hemilaminectomies performed through 5 small incisions of alternating laterality. After surgery, the patient experienced clinical improvement and was able to return to her baseline. CONCLUSION We illustrate a successful spinal decompression of extensive epidural lipomatosis through a less-invasive surgical approach using several small incisions to accomplish uninterrupted hemilaminectomies. This alternative approach to a standard continuous incision can be considered in cases of extensive spinal epidural lipomatosis in patients with multiple medical comorbidities in whom wound healing is believed to be an issue and for whom minimizing blood loss is crucial.
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Affiliation(s)
- Angelica M Fuentes
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Steven B Housley
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Robert V Starling
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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15
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Housley SB, Vakharia K, Gong AD, Waqas M, Rho K, Levy EI, Davies JM, Siddiqui AH. Extracranial-to-Intracranial Bypass for Distal Internal Carotid Artery and/or Proximal Middle Cerebral Artery Steno-Occlusive Disease: A Case Series of Clinical Outcomes at a Single, High-Volume Cerebrovascular Center. Oper Neurosurg (Hagerstown) 2022; 23:177-181. [PMID: 35972078 DOI: 10.1227/ons.0000000000000280] [Citation(s) in RCA: 3] [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] [Received: 04/02/2021] [Accepted: 03/07/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Extracranial-to-intracranial (EC-IC) bypass was first described by Yasargil in the 1960s for treatment of symptomatic distal internal carotid artery (ICA) and/or proximal middle cerebral artery (MCA) steno-occlusive disease through direct anastomosis. Subsequent bypass trials failed to demonstrate benefit for overall outcomes and stroke rates compared with best medical therapy. However, the procedure remained in the neurosurgeon's armament, with studies showing benefits in select patient populations. With advancements in technology, patient selection has become more comprehensive. OBJECTIVE To provide a contemporary evaluation of EC-IC bypass from our high-volume cerebrovascular center, focusing on associated clinical outcomes. METHODS Consecutive patients who underwent direct EC-IC bypass surgeries for symptomatic distal ICA and/or proximal MCA steno-occlusive disease between April 2015 and September 2019 were identified retrospectively. Medical records were reviewed to collect demographics, clinical presentation, computed tomography perfusion imaging findings, transcranial Doppler results, procedure indication, donor vessel types, anastomosis site, bypass patency, periprocedural complications, postprocedural complications, symptom recrudescence, repeat or new interventions, subjective improvements, and modified Rankin Scale scores. RESULTS We identified 27 patients who underwent 32 EC-IC bypass procedures. The rate of ipsilateral stroke was 9.4%, with a median follow-up of 8 months (IQR, 4-13 months). Patients experienced a 22.3% improvement in modified Rankin Scale scores, and 70.3% of patients reported subjective improvement and satisfaction at follow-up. CONCLUSION Direct EC-IC bypass remains a viable option for revascularization in symptomatic patients with distal ICA and/or proximal MCA steno-occlusive disease.
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Affiliation(s)
- Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
| | - Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
| | - Andrew D Gong
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.,Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
| | - Kyungduk Rho
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA.,Jacobs Institute, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA.,Jacobs Institute, Buffalo, New York, USA.,Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA.,Jacobs Institute, Buffalo, New York, USA
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16
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Monteiro A, Khan A, Donnelly BM, Kuo CC, Burke SM, Waqas M, Housley SB, Cappuzzo JM, Davies JM, Snyder KV, Levy EI, Siddiqui AH. Treatment of ruptured intracranial aneurysms using the novel generation of flow-diverters with surface modification: A systematic review and meta-analysis. Interv Neuroradiol 2022:15910199221117921. [PMID: 35929825 DOI: 10.1177/15910199221117921] [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: 11/16/2022] Open
Abstract
BACKGROUND Surface modification of flow diverters (FDs) has been explored as a solution for reducing thrombotic risk of these devices, without necessarily using dual antiplatelet therapy (DAPT). If effective, this could pose a promising alternative for treatment of ruptured aneurysms not amenable to other modalities. METHODS We performed a comprehensive search of PubMed, MEDLINE, and Embase databases following Preferred Reporting Items for Systematic reviews and Meta-analyzes guidelines. We included articles reporting use of surface-modified FDs for treatment of ruptured aneurysms. Demographics, subarachnoid hemorrhage (SAH) severity, aneurysm characteristics, devices used, periprocedural complications, angiographic outcomes, and mortality were extracted for sample size-based weighted analysis. RESULTS Six studies comprising 59 patients with 64 aneurysms were included. Mean patient age was 56.6 ± 6.3 years and 60.6% (95% confidence interval [CI], 46.7-72.9%) were women. The anterior circulation was the location in 60.4% (95%CI, 45.5-73.5%) of aneurysms; 41.8% of the aneurysms were saccular (95%CI, 29.3-55.4%), 16.7% were fusiform (95%CI, 8.3-30.8%), 29.9% were dissecting (95%CI, 12.8-55.4%), 24.4% were blood-blister (95%CI, 15.2-36.7%), and 5.7% were mycotic (95%CI, 2-15.1%). Poor SAH grade was reported in 46.9% (95%CI, 33.3-60.9%). Adjunctive coiling was used in 33.2% (95%CI, 12.4-63.6%). Periprocedural thromboembolic and hemorrhagic complications occurred in 20% (95%CI, 7.1-45.1%) and 8.8% (95%CI, 3.7-19.5%), respectively. Complete occlusion was achieved in 76.4% (95%CI, 58.1-88.3%); no retreatments during follow-up were reported. Overall mortality was 15.1% (95%CI, 7.7-27.6%). There were no differences between single antiplatelet therapy (SAPT) and DAPT regimens with respect to periprocedural thromboembolic complications (P = 0.09), hemorrhagic (P = 0.834) complications, and mortality (P = 0.312). CONCLUSION Surface-modified FD treatment of ruptured aneurysms resulted in high rates of thromboembolic complications and acceptable rates of hemorrhagic complications. A considerable proportion of aneurysms were nonsaccular. Rates of complete occlusion were high and retreatment were low. Importantly, no statistically significant difference was found between SAPT and DAPT with respect to complications and mortality.
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Affiliation(s)
- Andre Monteiro
- Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Asham Khan
- Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Brianna M Donnelly
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Cathleen C Kuo
- Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Samantha M Burke
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Muhammad Waqas
- Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Steven B Housley
- Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Justin M Cappuzzo
- Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Jason M Davies
- Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Department of Bioinformatics, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- 573848Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- 573848Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
| | - Elad I Levy
- Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- 573848Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- 573848Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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17
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Housley SB, Waqas M, Cappuzzo JM, Metcalf-Doetsch WN, Spiro RM, Levy EI. Delayed Cervical Carotid Revascularization After Missile Injury: A Technical Case Report. Oper Neurosurg (Hagerstown) 2022; 23:e147-e151. [PMID: 35838479 DOI: 10.1227/ons.0000000000000257] [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: 12/06/2021] [Accepted: 03/03/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Penetrating missile injury to the carotid arteries may lead to catastrophic hemorrhagic and/or ischemic complications. The incidence of carotid injury in patients with penetrating cervical trauma (PCT) is 11% to 13%, with most cases involving the common carotid artery (73%), followed by the internal carotid artery (ICA) (22%) and external carotid artery (5%). Approximately 50% of PCT cases result in mortality, with specific injury to the carotid arteries carrying nearly a 100% mortality rate. Although historically limited because most patients do not survive these serious injuries, treatment has become more feasible with advancements in endovascular techniques and technologies. CLINICAL PRESENTATION A young man presented to our trauma center after sustaining a gunshot wound to the right neck, leading to significant hemorrhage and ultimately a Biffl grade IV ICA injury. He was taken emergently to the operating room for cervical exploration and hemostasis. A computed tomography stroke study performed after initial stabilization revealed complete right ICA occlusion with increased time-to-peak in the right hemisphere. The patient was resuscitated to maintain sufficient cerebral perfusion pressure. Later, once hemodynamic stability was achieved, the patient underwent confirmatory angiography, followed by complete ICA revascularization using a balloon guide catheter to achieve flow arrest and placement of multiple carotid stents. He made a good neurological recovery. CONCLUSION Endovascular carotid artery revascularization may be performed successfully in the subacute phase after PCT. The use of flow arrest obtained with a balloon guide catheter assists in preventing catastrophic hemorrhage in the event of rupture.
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Affiliation(s)
- Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - William N Metcalf-Doetsch
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Richard M Spiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Erie County Medical Center, Buffalo, New York, USA.,Department of Diagnostic Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA.,Jacobs Institute, Buffalo, New York, USA
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18
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Housley SB, Cappuzzo JM, Waqas M, Levy EI. Facial Arteriovenous Malformation Embolized using n-BCA and Contrast Stasis rather than Tantalum Powder with Double Flow Arrest to Prevent Skin Discoloration: Technical Note. World Neurosurg 2022; 164:350-352. [PMID: 35690310 DOI: 10.1016/j.wneu.2022.06.001] [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: 05/02/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Arteriovenous malformations (AVM) are congenital errors of vascular morphogenesis that occur during development of the cardiovascular system. Multiple treatment options exist, including coil embolization, Onyx (Medtronic) embolization, n-butyl-2 cyanoacrylate (n-BCA), alcohol embolization or sclerotherapy, and open surgical treatments. When the AVM involves superficial regions of the face, head, and neck, it is important to consider cosmetic side effects, such as surgical scarring and skin discoloration. METHODS A 23-year-old woman presented with a large, anterior mandibulofacial AVM first identified on computed tomography angiography and confirmed with digital subtraction angiography. The lesion was subsequently embolized using n-BCA and contrast stasis for visualization during the procedure, instead of traditional tantalum powder. RESULTS Flow arrest accompanied by contrast stasis allowed changes in density observed using digital subtraction software, thus avoiding use of material that might be cosmetically disfiguring. CONCLUSION This technique for treatment of superficial AVMs avoids the use of materials that may be seen through or discolor the skin and other soft tissue.
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Affiliation(s)
- Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA.
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19
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Housley SB, Patel D, Nyabuto E, Reynolds RM. Spinal cord detethering without laminectomy or laminotomy. Surg Neurol Int 2021; 12:610. [PMID: 34992926 PMCID: PMC8720436 DOI: 10.25259/sni_942_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/09/2021] [Indexed: 11/04/2022] Open
Abstract
Background:
Tethered cord syndrome occurs when there is abnormal tension on the distal spinal cord, which limits its elevation as patients grow. This results in stretching of the neural elements and microvasculature, resulting in both direct and ischemic injury.[7] Animal studies suggest that impairment of oxidative metabolic pathways may contribute to neuronal injury.[7] Associated conditions include myelomeningocele, lipomyelomeningocele, intraspinal lipomas, diastematomyelia, thickened/fatty filum terminale, and trauma.[2] Tethering may be asymptomatic or result in a variety of symptoms including lower extremity weakness/sensory deficits, bowel/bladder dysfunction, scoliosis, pes cavus, and back/leg pain.[6] Early surgical intervention has been shown to improve outcomes and may be performed prophylactically or to prevent symptom progression.[1,3] More specifically, retrospective studies demonstrate that surgical intervention in patients under the age of 2 years is associated with improved outcomes.[5] In some cases, detethering may result in clinical improvement.[3]
Case Description:
We present a case of a 6-month-old male with a low-lying conus medullaris, lumbar syrinx, mildly abnormal urodynamic studies, and asymmetric utilization of his lower extremities observed during the evaluation of a Y-shaped gluteal cleft. He underwent elective spinal cord detethering via the safe and effective, minimally invasive technique described in the video.
The patient’s parents gave informed consent for treatment and video recording. Institutional review board approval was deemed unnecessary.
Conclusion:
Given the variety of surgical techniques used for cord detethering, this video may assist other surgeons in developing techniques that require little to no compromise of the developing bony spinal column while achieving sufficient release of the spinal cord.[4]
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Affiliation(s)
- Steven B. Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
| | - Devan Patel
- College of Medicine, Florida State University, Tallahassee, Florida, United States
| | - Elizabeth Nyabuto
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
| | - Renée M. Reynolds
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, John R. Oishei Children’s Hospital, Buffalo, New York, United States
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20
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Recker MJ, Housley SB, Lipinski LJ. Indolent nonendemic central nervous system histoplasmosis presenting as an isolated intramedullary enhancing spinal cord lesion. Surg Neurol Int 2021; 12:392. [PMID: 34513158 PMCID: PMC8422457 DOI: 10.25259/sni_345_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/08/2021] [Indexed: 11/04/2022] Open
Abstract
Background Histoplasma capsulatum infection is largely seen in endemic regions; it results in symptomatic disease in <5% of those infected and is most often a self-limiting respiratory disease. Disseminated histoplasmosis is considered rare in the immunocompetent host. Central nervous system (CNS) dissemination can result in meningitis, encephalitis, and focal lesions in the brain and spinal cord, stroke, and hydrocephalus. An intramedullary spinal cord lesion as the only manifestation of CNS histoplasmosis has been rarely described. Case Description We present an atypical case of a 44-year-old man from a nonendemic region, on adalimumab therapy for ulcerative colitis who developed an isolated intramedullary spinal cord lesion in the setting of disseminated histoplasmosis. His course was initially indolent with vague systemic symptoms that led to consideration of several other diagnoses including sarcoidosis and lymphoma. Biopsies of several positron emission tomography positive lymph nodes revealed granulomatous inflammation, but no firm diagnosis was achieved. He was ultimately diagnosed with histoplasmosis after an acute respiratory infection in the setting of anti-tumor necrosis factor therapy. With appropriate antifungal therapy, the spinal cord lesion regressed. The previous systemic biopsies were re-reviewed, and rare fungal elements consistent with H. capsulatum were identified. A presumptive diagnosis of CNS histoplasmosis was made in the absence of direct laboratory confirmation in the setting of rapid and complete resolution on antifungal therapy. Conclusion Disseminated histoplasmosis should be considered in granulomatous disease, even if the patient resides in a nonendemic region. Furthermore, clinicians should be mindful that CNS histoplasmosis may present in an atypical fashion.
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Affiliation(s)
- Matthew J Recker
- Department of Neurosurgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States.,Department of Neurosurgery, Jacobs School of Medicine at the University at Buffalo, Buffalo New York, United States
| | - Steven B Housley
- Department of Neurosurgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States.,Department of Neurosurgery, Jacobs School of Medicine at the University at Buffalo, Buffalo New York, United States
| | - Lindsay J Lipinski
- Department of Neurosurgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States.,Department of Neurosurgery, Jacobs School of Medicine at the University at Buffalo, Buffalo New York, United States
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21
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Lim J, Housley SB, Drumsta D, Spiro RM. Chronic epidural hematoma presenting with diplopia. Surg Neurol Int 2021; 12:420. [PMID: 34513184 PMCID: PMC8422440 DOI: 10.25259/sni_480_2021] [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: 05/15/2021] [Accepted: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Epidural hematomas are common intracranial pathologies secondary to traumatic brain injuries and are associated with overlying skull fractures up to 85% of the time. Although many require immediate surgical evacuation, some are observed for stability and followed up conservatively with serial imaging or enlarge slowly overtime, similar to chronic subdural hematomas. Those in the latter category may present with vague symptoms such as diplopia or headache and are often found on routine outpatient evaluation. When concerning findings such as significant mass effect are present, surgical evacuation is necessary. Case Description: Here, we present the case of a 32-year-old man who presented with diplopia 6 weeks after experiencing head trauma and was found to have a chronic epidural hematoma. On resection, thick, inflammatory tissue was observed and carefully resected, revealing normal dura underneath. Six weeks after evacuation of the hematoma, the patient had near-complete resolution of his diplopia and complete resolution of his epidural hematoma. Conclusion: Given the consistency and nature of the fibrous material observed intraoperatively in this case, near-complete resection of the tissue was likely necessary to help facilitate adequate reexpansion of brain parenchyma and improve clinical outcomes.
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Affiliation(s)
- Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States.,Department of Neurosurgery, Erie County Medical Center, Buffalo, New York, United States
| | - Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States.,Department of Neurosurgery, Erie County Medical Center, Buffalo, New York, United States
| | - Douglas Drumsta
- Department of Diagnostic Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States.,Department of Radiology, Eric County Medical Center, Buffalo, New York, United States
| | - Richard M Spiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States.,Department of Neurosurgery, Erie County Medical Center, Buffalo, New York, United States.,Department of Diagnostic Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
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22
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Waqas M, Gong AD, Dossani RH, Cappuzzo JM, Rho K, Lim J, Housley SB, Shakir HJ, Siddiqui AH, Levy EI. Social Media Use Among Neurosurgery Trainees: A Survey of North American Training Programs. World Neurosurg 2021; 154:e605-e615. [PMID: 34325027 DOI: 10.1016/j.wneu.2021.07.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Social media have revolutionized access to educational content. Given the extensive presence of social media, these platforms have the potential to influence neurosurgical training and education of residents and fellows. We explored the attitudes of neurosurgical trainees (postgraduate years 1-9) toward social media and their perceived influence on training and education. METHODS This study was a survey of trainees at North American neurosurgery residency programs. A 22-item survey, including 2 free-text questions, was distributed through the Congress of Neurological Surgeons listserv. The survey consisted of questions regarding demographics, social media platform use, and trainee views on social media; their perceived impact on education and job performance was gauged using a 5-point Likert scale. Descriptive analysis was performed. RESULTS The survey was disseminated to 1160 neurosurgery trainees, with a response rate of 15.3%. Of 178 respondents, 132 (74.2%) were men; 142 (79.8%) were 25-34 years old. All respondents used social media. The most commonly used platforms were Facebook (87.1%), followed by YouTube (84.3%), Instagram (81.5%), and Twitter (74.7%). The most common reasons for social media use were personal social (89.8%), networking (65.5%), and academic resources (65.0%); 113 respondents (63.5%) reported spending <25% of their time on social media for academics. The Neurosurgical Atlas (63.3%), Congress of Neurological Surgeons (11.2%), and American Association of Neurological Surgeons (10.1%) social media accounts were the most commonly used academic platforms. CONCLUSIONS Social media use was ubiquitous among trainees. Although most used social media for personal social communication, most also used it for academic purposes.
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Affiliation(s)
- Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Andrew D Gong
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Rimal H Dossani
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Kyungduk Rho
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Hakeem J Shakir
- Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA.
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23
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Housley SB, Recker MJ, O’Connor TE, Siddiqui AH. Infundibular hemangioblastoma resection: Video case report. Surg Neurol Int 2021; 12:296. [PMID: 35592353 PMCID: PMC9112985 DOI: 10.25259/sni_288_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/13/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Hemangioblastomas are benign (World Health Organization Grade I), highly vascular neoplasms commonly associated with Von Hippel-Lindau (VHL) disease.[2] The VHL tumor-suppressor gene, located on chromosome 3, is implicated in sporadic cases and cases associated with VHL disease. Hemangioblastomas most commonly arise in the posterior fossa; however, they may also be found supratentorially or within the spinal cord.[3] Surgical intervention is indicated for symptomatic lesions with a goal of complete resection of the enhancing nodule.[1] Case Description: We demonstrate the case of a 69-year-old man with a history of multiple hemangioblastomas who had undergone two previous craniotomies and Gamma-Knife radiosurgery (Video https://drive.google.com/file/d/1lUwsb80NLmIW2Enp-DVdtM9_Oqbid3Ih/view?usp=sharing). He presented with progressive imbalance and diplopia and was found to have a new lesion within the suprasellar cistern. Digital subtraction angiography (DSA) and magnetic resonance imaging (MRI) characteristics were typical of hemangioblastoma. Surgery was determined to be indicated, with a goal of vision preservation. Preoperative embolization was not possible because preoperative DSA demonstrated vascular supply by only small perforators directly from the internal carotid artery. Hypopituitarism was identified preoperatively, although diabetes insipidus was not present. The patient underwent a right orbitozygomatic craniotomy and extradural anterior clinoidectomy for access. The tumor was noted to encapsulate the infundibulum, which necessitated its sacrifice. Postoperatively, the patient remained at his neurologic baseline. He had a positive triphasic diabetes insipidus response and was discharged home on maintenance desmopressin. Postoperative MRI demonstrated complete lesion resection. The patient gave informed consent for treatment and video recording. Institutional review board approval was deemed unnecessary. Conclusion: This video highlights a safe and effective surgical technique for suprasellar lesions as well as the complex anatomy observed through an orbitozygomatic approach.
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Affiliation(s)
- Steven B. Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
| | - Matthew J. Recker
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
| | - Timothy E. O’Connor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
| | - Adnan H. Siddiqui
- Departments of Neurosurgery and Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
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24
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Vakharia K, Housley SB, Waqas M, Davies JM, Levy EI. Management of Iatrogenic Internal Carotid Artery Injury During Medial Sphenoid Wing Meningioma Resection: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 20:E55-E56. [PMID: 33047130 DOI: 10.1093/ons/opaa310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/19/2020] [Indexed: 11/14/2022] Open
Abstract
Medial sphenoid wing meningiomas constitute up to 10% of all intracranial meningiomas.1 These meningiomas have a tendency to engulf the internal carotid artery (ICA), its termination, and the middle cerebral artery. These arteries and the optic apparatus are at a particularly high risk of injury during the microsurgical resection of these tumors. ICA injuries are potentially devastating and challenging to manage. In this technical video, we demonstrate the management of inadvertent ICA terminus injury during the microsurgical resection of the medial sphenoid. Rapid vascular control was obtained with temporary clips on the ICA and anterior cerebral artery (ACA). Tamponade with a felt and primary repair of the arterial tear were attempted without success. We then created a tamponade around the tear with the help of a Hemashield strip (Meadox Medicals, Oakland, New Jersey), which was secured with a 90-degree-angled clip. Temporary clips were removed, and microsurgical dissection was completed. The Hemashield strip was removed at the end of the procedure. This maneuver resulted in complete hemostasis. Vascular patency was confirmed using Doppler imaging and intraoperative indocyanine green angiography. Postoperatively, the patient had transient right-sided weakness, which resolved 2 d later. The patient was discharged without any neurological deficit. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Video ©University at Buffalo, April 2020. Published with permission.
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Affiliation(s)
- Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York.,Jacobs Institute, Buffalo, New York
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York.,Jacobs Institute, Buffalo, New York.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
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25
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Housley SB, Vakharia K, Waqas M, Siddiqui AH. Cerebral hypoperfusion necessitating additional bypass following hunterian ligation of the internal carotid artery despite reassuring intraoperative challenges: Video case report. Surg Neurol Int 2021; 12:22. [PMID: 33598338 PMCID: PMC7881615 DOI: 10.25259/sni_593_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: 08/30/2020] [Accepted: 12/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Hunterian ligation has been adapted for complex intracranial aneurysm repair when other, more modern techniques are insufficient. Before drastic alteration of cerebral blood flow dynamics, intraoperative challenges and consideration of blood flow dynamics must be completed to ensure adequate perfusion postligation. On satisfaction, ligation may proceed; however, subtle changes related to hypoperfusion may not be immediately observed during intraoperative challenge under general anesthesia and/or before onset of the vasospasm window. Case Description: In this report, we describe a patient who presented with a Hunt-Hess Grade III subarachnoid hemorrhage (SAH), with a right internal carotid artery (ICA) occlusion and a ruptured giant left ICA aneurysm. Endovascular treatment of the aneurysm was aborted because the nominal, 9 mm diameter of the ICA was too large for any intracranial balloon or stent. Three days later, she underwent a left-sided “insurance” extracranial-tointracranial arterial bypass (EIAB) using the superficial temporal artery simultaneously with hunterian ligation of the left ICA following reassuring results on intraoperative occlusion challenge. Over several days, her neurologic condition declined concurrent with the vasospasm window, and a right-sided EIAB was required to augment vascular supply. Following a protracted hospital course, the patient became progressively more independent and is currently residing in an assisted living facility. Conclusion: We illustrate an ultimately successful microsurgical treatment option in the setting of acute SAH that highlights the importance of cerebrovascular reserve and blood flow replacement in the setting of a compromised circle of Willis, especially during the vasospasm window.
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Affiliation(s)
- Steven B Housley
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Kunal Vakharia
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Muhammad Waqas
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
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Waqas M, Vakharia K, Levy BR, Housley SB, Dossani RH, Gong A, Cappuzzo J, Levy EI. Rapid temporary coiling of the parent artery for the management of intraprocedural aneurysm rupture. Brain Circ 2020; 6:274-279. [PMID: 33506151 PMCID: PMC7821804 DOI: 10.4103/bc.bc_54_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 11/19/2022] Open
Abstract
Intraprocedural rupture (IPR) of an intracranial aneurysm is the most feared complication of primary and stent-assisted coiling because it carries a high risk of morbidity and mortality. The endovascular strategy applied to control IPR depends on the cause of the rupture and stage of the procedure. Rupture during primary or stent-assisted coiling is traditionally managed with the use of continued packing, balloon microcatheter placement, or in rare cases, with parent artery sacrifice. In this technical note, we describe the use of temporary coiling of the parent artery to control IPR in three cases. Temporary parent artery coiling creates a subocclusive state, resulting in aneurysmal blood flow reduction without interruption of blood flow to the distal territory. Flow reduction combined with the thrombogenicity of the previously deployed coils results in hemostasis. In the cases presented here, IPR occurred during the late stage of coiling. In each case, parent artery coiling was performed along with heparin reversal. After confirmation of hemostasis, the coils were retrieved to restore normal blood flow. We demonstrate that the technique of temporary parent artery coiling may be a safe and effective option for the management of IPR during primary or stent-assisted coiling.
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Affiliation(s)
- Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Bennett R Levy
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Rimal H Dossani
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Andrew Gong
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Justin Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA.,Jacobs Institute, Buffalo, New York, USA
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Housley SB, Hoffman A, Siddiqui AH. Ventriculoperitoneal shunt placement with ultrasound guidance and laparoscopic assistance: 2-dimensional instructional video. Surg Neurol Int 2020; 11:82. [PMID: 32844047 PMCID: PMC7193460 DOI: 10.25259/sni_8_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: 01/07/2020] [Accepted: 03/16/2020] [Indexed: 11/04/2022] Open
Abstract
Background Postoperative communicating hydrocephalus has been described in the literature commonly associated with treatment of ruptured intracranial aneurysms; however, it is also reported to occur following other intracranial interventions such as meningioma resection and decompressive hemicraniectomy. In 2011, Burkhardt et al. reported the incidence of postoperative hydrocephalus following skull base meningioma resection was twice as high as resection of meningiomas in other regions.[1] They found that age and increased length of surgery were associated with higher rates of postoperative hydrocephalus. Our patient, a 76-year-old man, initially presented with the left-hand paresthesias and numbness before the revelation of a large sphenoid planum meningioma on workup imaging. He underwent surgical resection due to developing cranial nerve deficits and personality changes in an extensive procedure that required approximately 8 h to complete. His postoperative course, given the factors above, included the development of hydrocephalus. Case Description He was taken to the operating room for ventriculoperitoneal shunt placement, as displayed in this video case report, which highlights our surgical and sterile techniques, intraoperative ultrasound to ensure appropriate ventricular placement, and a single-port laparoscopic technique for direct visualization of placement of the abdominal catheter. After shunt placement, his course was complicated by a small tract hemorrhage, which resolved without further treatment. He was observed to have an improvement in mental function that occurred over the following 2-3 days before being discharged to an outpatient rehabilitation facility for continued care. Conclusion Ventriculoperitoneal shunt placement is an effective and safe procedure for the treatment of postoperative communicating hydrocephalus when performed with appropriate techniques as displayed in the associated video case report. The patient gave informed consent for surgery and video recording. Institutional Review Board approval was deemed unnecessary.
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Affiliation(s)
- Steven B Housley
- Departments of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Aaron Hoffman
- Department of Bariatrics, Buffalo General Medical Center, Buffalo, New York, USA.,Department of General Surgery, John R Oishei Children's Hospital, New York, USA
| | - Adnan H Siddiqui
- Departments of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.,Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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Housley SB, Vakharia K, Waqas M, Davies JM, Siddiqui AH. Mechanical venous thrombectomy and prolonged infusion of tissue plasminogen activator for cerebral venous sinus thrombosis: Video case report. Surg Neurol Int 2020; 11:193. [PMID: 32754364 PMCID: PMC7395561 DOI: 10.25259/sni_71_2020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Cerebral venous sinus thrombosis (CVST) is a rare and often misdiagnosed condition with mortality rates ranging from 6 to 10%. Diagnosis and monitoring are typically achieved through noninvasive imaging, including computed tomography or magnetic resonance venography. The current standard of treatment is systemic anticoagulation. However, in patients who continue to decline neurologically or do not show sufficient response to or have absolute contraindications to systemic anticoagulation, endovascular treatments are an alternative. Endovascular options are poorly studied and specific devices have not been developed, partially due to the rare nature of the disease. Here, we present a case report detailing the treatment of extensive CVST from the vein of Galen to the sigmoid sinus using mechanical thrombectomy and local infusions of unfractionated heparin (UFH) and tissue plasminogen activator. Case Description: A 53-year-old man presented and was found to have extensive CVST extending from the vein of Galen to the left sigmoid sinus. Systemic UFH was begun; however, his condition continued to decline, and he was taken for endovascular intervention, wherein mechanical thrombectomy was undertaken using combinations of stent retrievers and balloon catheters, which provided acceptable revascularization. Unfortunately, his hospital course was further complicated by a cerebellar hematoma that was surgically evacuated and reocclusion of the sinus for which a microcatheter was placed for infusion of UFH and tissue plasminogen activator. Conclusion: Complicated CVST may require aggressive endovascular management. Local infusions of heparin and thrombolytic agents as well as mechanical thrombectomy are safe alternative options.
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Affiliation(s)
- Steven B Housley
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Kunal Vakharia
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Muhammad Waqas
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Jason M Davies
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
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Rajah GB, Waqas M, Dossani RH, Vakharia K, Gong AD, Rho K, Housley SB, Rai HH, Chin F, Tso MK, Snyder KV, Levy EI, Siddiqui AH, Davies JM. Transradial middle meningeal artery embolization for chronic subdural hematoma using Onyx: case series. J Neurointerv Surg 2020; 12:1214-1218. [DOI: 10.1136/neurintsurg-2020-016185] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023]
Abstract
BackgroundMiddle meningeal artery (MMA) embolization is an emerging therapy for the resolution of subacute or chronic subdural hematoma (CSDH). CSDH patients are often elderly and have several comorbidities. We evaluated our experience with transradial access (TRA) for MMA embolization using predominantly Onyx under conscious sedation.MethodsData for consecutive patients who underwent transradial MMA embolization for CSDH during a 2-year period (2018–2019) were analyzed from a single-center, prospectively-maintained database. Patient demographics, comorbidities, ambulatory times, subdural hematoma resorption status, and guide catheter type were recorded. Conversion to femoral access and complication rates were also recorded. Univariate and multivariate analyses were performed.ResultsForty-six patients (mean age, 71.7±14.4 years) were included in this study. Mean CSDH size was 14±5.5 mm. Most (91.3%) TRA embolizations were performed with 6-French 0.071-inch Benchmark guide catheters (Penumbra). MMA embolization was successful in 44 patients (95.7%) (including two cases of TRA conversion). Twenty-one (48%) patients had a severe Charlson Comorbidity Index (>5). Symptomatic improvement was noted in 39 of 44 patients (88.6%). Mean length of stay was 4±3 days. Patients were ambulated immediately postprocedure. At mean follow-up (8±4 weeks), 86.4% of patients had complete or partial CSDH resolution. Persistent use of antiplatelet agents after the procedure was associated with failed or minimal CSDH resorption (5 of 6, 83.3% vs 9 of 38 23.7% with complete or near-complete resolution; P=0.009).ConclusionTransradial Onyx MMA embolization under conscious sedation is safe and effective for CSDH treatment. TRA may be especially useful in elderly patients with numerous comorbidities.
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Housley SB, Vakharia K, Winograd EK, Siddiqui AH. Endoscopic Carpal Tunnel Release. World Neurosurg 2020; 139:548. [PMID: 32348893 DOI: 10.1016/j.wneu.2020.04.123] [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: 01/16/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
Carpal tunnel syndrome represents compression of the median nerve in the carpal tunnel, which is defined by the carpal bones on the lateral, medial, and dorsal aspects and the transverse carpal ligament on the anterior aspect.1 Symptoms of carpal tunnel syndrome include paresthesia, anesthesia, paresis, and pain located in the median nerve distribution. In severe cases, there may be atrophy of median nerve-innervated thenar muscles. In the United States, carpal tunnel syndrome affects approximately 3.72% of the population.2 Conservative measures, such as bracing, steroid injections, and physical and occupational therapy, are commonly employed.1 However, many patients still require more definitive surgical management, which may be in the form of open or endoscopic procedures. Regardless of surgical approach, the clinical success rates of carpal tunnel release have been reported to be 75%-90%.3 Recurrence rates are 8.4%-15% over 4-5 years,4,5 with the lower end of this range representing the Agee single-portal technique. Endoscopic carpal tunnel release leads to reduced postoperative pain and an increase in transient neurologic deficits; however, no improvements have been reported in overall complication rate, subjective satisfaction, return to work, postoperative grip and pinch strength, and operative time.6 In this technical video, we present a case of single-incision endoscopic carpal tunnel release in a patient with severe symptoms after conservative measures failed. The patient experienced a noncomplicated postoperative course and demonstrated an excellent recovery at follow-up visits. Surgical decompression is an important treatment for refractory carpal tunnel syndrome, and videos such as this provide guidance for safe and effective treatment (Video 1).
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Affiliation(s)
- Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Evan K Winograd
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA.
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Quadri Z, Johnson N, Zamudio F, Miller A, Peters M, Smeltzer S, Hunt JB, Housley SB, Brown B, Kraner S, Norris CM, Nash K, Weeber E, Lee DC, Selenica MLB. Overexpression of human wtTDP-43 causes impairment in hippocampal plasticity and behavioral deficits in CAMKII-tTa transgenic mouse model. Mol Cell Neurosci 2019; 102:103418. [PMID: 31705957 DOI: 10.1016/j.mcn.2019.103418] [Citation(s) in RCA: 4] [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: 05/07/2019] [Revised: 10/23/2019] [Accepted: 10/31/2019] [Indexed: 12/13/2022] Open
Abstract
AIMS The current study utilizes the adeno-associated viral gene transfer system in the CAMKIIα-tTA mouse model to overexpress human wild type TDP-43 (wtTDP-43) and α-synuclein (α-Syn) proteins. The co-existence of these proteins is evident in the pathology of neurodegenerative disorders such as frontotemporal lobar degeneration (FTLD), Parkinson disease (PD), and dementia with Lewy bodies (DLB). METHODS The novel bicistronic recombinant adeno-associated virus (rAAV) serotype 9 drives wtTDP-43 and α-Syn expression in the hippocampus via "TetO" CMV promoter. Behavior, electrophysiology, and biochemical and histological assays were used to validate neuropathology. RESULTS We report that overexpression of wtTDP-43 but not α-Syn contributes to hippocampal CA2-specific pyramidal neuronal loss and overall hippocampal atrophy. Further, we report a reduction of hippocampal long-term potentiation and decline in learning and memory performance of wtTDP-43 expressing mice. Elevated wtTDP-43 levels induced selective degeneration of Purkinje cell protein 4 (PCP-4) positive neurons while both wtTDP-43 and α-Syn expression reduced subsets of the glutamate receptor expression in the hippocampus. CONCLUSIONS Overall, our findings suggest the significant vulnerability of hippocampal neurons toward elevated wtTDP-43 levels possibly via PCP-4 and GluR-dependent calcium signaling pathways. Further, we report that wtTDP-43 expression induced selective CA2 subfield degeneration, contributing to the deterioration of the hippocampal-dependent cognitive phenotype.
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Affiliation(s)
- Zainuddin Quadri
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA; Byrd Alzheimer's Institute, University of South Florida, Tampa, FL, USA
| | - Nicholas Johnson
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA; Byrd Alzheimer's Institute, University of South Florida, Tampa, FL, USA
| | - Frank Zamudio
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA; Byrd Alzheimer's Institute, University of South Florida, Tampa, FL, USA
| | - Abraian Miller
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA; Byrd Alzheimer's Institute, University of South Florida, Tampa, FL, USA
| | - Melinda Peters
- Byrd Alzheimer's Institute, University of South Florida, Tampa, FL, USA; Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Shayna Smeltzer
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA; Byrd Alzheimer's Institute, University of South Florida, Tampa, FL, USA
| | - Jerry B Hunt
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA; Byrd Alzheimer's Institute, University of South Florida, Tampa, FL, USA
| | - Steven B Housley
- Byrd Alzheimer's Institute, University of South Florida, Tampa, FL, USA; Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Breanna Brown
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA; Byrd Alzheimer's Institute, University of South Florida, Tampa, FL, USA
| | - Susan Kraner
- Sanders-Brown Center on Aging, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Christopher M Norris
- Sanders-Brown Center on Aging, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Kevin Nash
- Byrd Alzheimer's Institute, University of South Florida, Tampa, FL, USA; Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Edwin Weeber
- Byrd Alzheimer's Institute, University of South Florida, Tampa, FL, USA; Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Daniel C Lee
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA; Byrd Alzheimer's Institute, University of South Florida, Tampa, FL, USA
| | - Maj-Linda B Selenica
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA; Byrd Alzheimer's Institute, University of South Florida, Tampa, FL, USA.
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Selenica MLB, Davtyan H, Housley SB, Blair LJ, Gillies A, Nordhues BA, Zhang B, Liu J, Gestwicki JE, Lee DC, Gordon MN, Morgan D, Dickey CA. Epitope analysis following active immunization with tau proteins reveals immunogens implicated in tau pathogenesis. J Neuroinflammation 2014; 11:152. [PMID: 25183004 PMCID: PMC4167523 DOI: 10.1186/s12974-014-0152-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/14/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Abnormal tau hyperphosphorylation and its accumulation into intra-neuronal neurofibrillary tangles are linked to neurodegeneration in Alzheimer's disease and similar tauopathies. One strategy to reduce accumulation is through immunization, but the most immunogenic tau epitopes have so far remained unknown. To fill this gap, we immunized mice with recombinant tau to build a map of the most immunogenic tau epitopes. METHODS Non-transgenic and rTg4510 tau transgenic mice aged 5 months were immunized with either human wild-type tau (Wt, 4R0N) or P301L tau (4R0N). Each protein was formulated in Quil A adjuvant. Sera and splenocytes of vaccinated mice were collected to assess the humoral and cellular immune responses to tau. We employed a peptide array assay to identify the most effective epitopes. Brain histology was utilized to measure the effects of vaccination on tau pathology and inflammation. RESULTS Humoral immune responses following immunization demonstrated robust antibody titers (up to 1:80,000 endpoint titers) to each tau species in both mice models. The number of IFN-γ producing T cells and their proliferation were also increased in splenocytes from immunized mice, indicating an increased cellular immune response, and tau levels and neuroinflammation were both reduced. We identified five immunogenic motifs within either the N-terminal (9-15 and 21-27 amino acids), proline rich (168-174 and 220-228 amino acids), or the C-terminal regions (427-438 amino acids) of the wild-type and P301L tau protein sequence. CONCLUSIONS Our study identifies five previously unknown immunogenic motifs of wild-type and mutated (P301L) tau protein. Immunization with both proteins resulted in reduced tau pathology and neuroinflammation in a tau transgenic model, supporting the efficacy of tau immunotherapy in tauopathy.
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Affiliation(s)
- Maj-Linda B Selenica
- />Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612 USA
- />USF Health, Byrd Alzheimer Institute, 4001 E. Fowler Avenue, MDC 36, Tampa, FL 33613 USA
| | - Hayk Davtyan
- />Department of Molecular Immunology, Institute for Molecular Medicine, 16371 Gothard Street, H, Huntington Beach, CA 92647 USA
- />Institute for Memory Impairments and Neurological Disorders, University of California, 2642 Biological Sciences III, Irvine, CA 92697 USA
| | - Steven B Housley
- />USF Health, Byrd Alzheimer Institute, 4001 E. Fowler Avenue, MDC 36, Tampa, FL 33613 USA
- />Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612 USA
| | - Laura J Blair
- />USF Health, Byrd Alzheimer Institute, 4001 E. Fowler Avenue, MDC 36, Tampa, FL 33613 USA
- />Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, 4001 E. Fowler Avenue, MDC 36, Tampa, FL 33613 USA
| | - Anne Gillies
- />Life Sciences Institute, University of Michigan, Ann Arbor, MI USA
| | - Bryce A Nordhues
- />USF Health, Byrd Alzheimer Institute, 4001 E. Fowler Avenue, MDC 36, Tampa, FL 33613 USA
- />Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, 4001 E. Fowler Avenue, MDC 36, Tampa, FL 33613 USA
| | - Bo Zhang
- />USF Health, Byrd Alzheimer Institute, 4001 E. Fowler Avenue, MDC 36, Tampa, FL 33613 USA
- />Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, 4001 E. Fowler Avenue, MDC 36, Tampa, FL 33613 USA
| | - Joseph Liu
- />Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612 USA
- />USF Health, Byrd Alzheimer Institute, 4001 E. Fowler Avenue, MDC 36, Tampa, FL 33613 USA
| | - Jason E Gestwicki
- />Life Sciences Institute, University of Michigan, Ann Arbor, MI USA
| | - Daniel C Lee
- />Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612 USA
- />USF Health, Byrd Alzheimer Institute, 4001 E. Fowler Avenue, MDC 36, Tampa, FL 33613 USA
| | - Marcia N Gordon
- />USF Health, Byrd Alzheimer Institute, 4001 E. Fowler Avenue, MDC 36, Tampa, FL 33613 USA
- />Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612 USA
| | - Dave Morgan
- />USF Health, Byrd Alzheimer Institute, 4001 E. Fowler Avenue, MDC 36, Tampa, FL 33613 USA
- />Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612 USA
| | - Chad A Dickey
- />USF Health, Byrd Alzheimer Institute, 4001 E. Fowler Avenue, MDC 36, Tampa, FL 33613 USA
- />Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, 4001 E. Fowler Avenue, MDC 36, Tampa, FL 33613 USA
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Selenica ML, Benner L, Housley SB, Manchec B, Lee DC, Nash KR, Kalin J, Bergman JA, Kozikowski A, Gordon MN, Morgan D. Histone deacetylase 6 inhibition improves memory and reduces total tau levels in a mouse model of tau deposition. Alzheimers Res Ther 2014; 6:12. [PMID: 24576665 PMCID: PMC3978441 DOI: 10.1186/alzrt241] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 02/24/2014] [Indexed: 11/27/2022]
Abstract
Introduction Tau pathology is associated with a number of age-related neurodegenerative disorders. Few treatments have been demonstrated to diminish the impact of tau pathology in mouse models and none are yet effective in humans. Histone deacetylase 6 (HDAC6) is an enzyme that removes acetyl groups from cytoplasmic proteins, rather than nuclear histones. Its substrates include tubulin, heat shock protein 90 and cortactin. Tubastatin A is a selective inhibitor of HDAC6. Modification of tau pathology by specific inhibition of HDAC6 presents a potential therapeutic approach in tauopathy. Methods We treated rTg4510 mouse models of tau deposition and non-transgenic mice with tubastatin (25 mg/kg) or saline (0.9%) from 5 to 7 months of age. Cognitive behavior analysis, histology and biochemical analysis were applied to access the effect of tubastatin on memory, tau pathology and neurodegeneration (hippocampal volume). Results We present data showing that tubastatin restored memory function in rTg4510 mice and reversed a hyperactivity phenotype. We further found that tubastatin reduced the levels of total tau, both histologically and by western analysis. Reduction in total tau levels was positively correlated with memory improvement in these mice. However, there was no impact on phosphorylated forms of tau, either by histology or western analysis, nor was there an impact on silver positive inclusions histologically. Conclusion Potential mechanisms by which HDAC6 inhibitors might benefit the rTg4510 mouse include stabilization of microtubules secondary to increased tubulin acetylation, increased degradation of tau secondary to increased acetylation of HSP90 or both. These data support the use of HDAC6 inhibitors as potential therapeutic agents against tau pathology.
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Affiliation(s)
- Maj-Linda Selenica
- Byrd Alzheimer's Institute, University of South Florida, Tampa, FL 33613, USA ; College of Pharmacy, Department of Pharmaceutical Sciences, University of South Florida, Tampa, FL 33612, USA
| | - Leif Benner
- Byrd Alzheimer's Institute, University of South Florida, Tampa, FL 33613, USA
| | - Steven B Housley
- Byrd Alzheimer's Institute, University of South Florida, Tampa, FL 33613, USA
| | - Barbara Manchec
- Byrd Alzheimer's Institute, University of South Florida, Tampa, FL 33613, USA
| | - Daniel C Lee
- Byrd Alzheimer's Institute, University of South Florida, Tampa, FL 33613, USA ; College of Pharmacy, Department of Pharmaceutical Sciences, University of South Florida, Tampa, FL 33612, USA
| | - Kevin R Nash
- Byrd Alzheimer's Institute, University of South Florida, Tampa, FL 33613, USA ; College of Medicine, Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL 33612, USA
| | - Jay Kalin
- Department of Pharmacology and Molecular Science, The Johns Hopkins University, School of Medicine, Baltimore, MD 21205, USA
| | - Joel A Bergman
- Drug Discovery Program, Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Alan Kozikowski
- Drug Discovery Program, Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Marcia N Gordon
- Byrd Alzheimer's Institute, University of South Florida, Tampa, FL 33613, USA ; College of Medicine, Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL 33612, USA
| | - Dave Morgan
- Byrd Alzheimer's Institute, University of South Florida, Tampa, FL 33613, USA ; College of Medicine, Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL 33612, USA
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