1
|
Beslow LA, Krings T, Kim H, Hetts SW, Lawton MT, Ratjen F, Whitehead KJ, Gossage JR, McCulloch CE, Clancy M, Bagheri N, Faughnan ME. De Novo Brain Vascular Malformations in Hereditary Hemorrhagic Telangiectasia. Pediatr Neurol 2024; 155:120-125. [PMID: 38631080 DOI: 10.1016/j.pediatrneurol.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/26/2024] [Accepted: 03/15/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Approximately 10% of people with hereditary hemorrhagic telangiectasia (HHT) have brain vascular malformations (VMs). Few reports describe de novo brain VM formation. International HHT Guidelines recommend initial brain VM screening upon HHT diagnosis in children but do not address rescreening. We aimed to confirm whether brain VMs can form de novo in patients with HHT. METHODS The Brain Vascular Malformation Consortium HHT project is a 17-center longitudinal study enrolling patients since 2010. We analyzed the database for de novo VMs defined as those detected (1) on follow-up neuroimaging in a patient without previous brain VMs or (2) in a location distinct from previously identified brain VMs and reported those in whom a de novo VM could be confirmed on central neuroimaging review. RESULTS Of 1909 patients enrolled, 409 (21%) had brain VMs. Seven patients were recorded as having de novo brain VMs, and imaging was available for central review in four. We confirmed that three (0.7% of individuals with brain VMs) had de novo brain VMs (two capillary malformations, one brain arteriovenous malformation) with intervals of six, nine, and 13 years from initial imaging. Two with de novo brain VMs were <18 years. The fourth patient, a child, did not have a de novo brain VM but had a radiologically confirmed increase in size of an existing brain arteriovenous malformation. CONCLUSIONS Brain VMs can, albeit rarely, form de novo in patients with HHT. Given the potential risk of hemorrhage from brain VMs, regular rescreening in patients with HHT may be warranted.
Collapse
Affiliation(s)
- Lauren A Beslow
- Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Timo Krings
- Division of Neuroradiology, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Helen Kim
- Department of Anesthesia, University of California - San Francisco, San Francisco, California
| | - Steven W Hetts
- Division of Neurointerventional Radiology, University of California - San Francisco, San Francisco, California
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Felix Ratjen
- Department of Paediatrics, Division of Paediatric Respiratory Medicine, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Kevin J Whitehead
- Departments of Internal Medicine and Pediatrics, The University of Utah, Salt Lake City, Utah
| | - James R Gossage
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Charles E McCulloch
- Department of Epidemiology & Biostatistics, University of California - San Francisco, San Francisco, California
| | | | - Negar Bagheri
- Toronto HHT Centre, Department of Medicine, St. Michael's Hospital and Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
| | - Marie E Faughnan
- Toronto HHT Centre, Department of Medicine, St. Michael's Hospital and Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Beslow LA, Vossough A, Kim H, Nelson J, Lawton MT, Pollak J, Lin DDM, Ratjen F, Hammill AM, Hetts SW, Gossage JR, Whitehead KJ, Faughnan ME, Krings T. Brain AVM compactness score in children with hereditary hemorrhagic telangiectasia. Childs Nerv Syst 2024:10.1007/s00381-024-06366-z. [PMID: 38517485 DOI: 10.1007/s00381-024-06366-z] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/14/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE The brain arteriovenous malformation (BAVM) nidus compactness score (CS), determined on angiography, predicts BAVM recurrence after surgical resection among children with sporadic BAVMs. We measured the angiographic CS for BAVMs among children with hereditary hemorrhagic telangiectasia (HHT) to determine CS characteristics in this population. METHODS A pediatric interventional neuroradiologist reviewed angiograms to determine the CS of BAVMs in children with HHT recruited to the BVMC. CS is based on overall nidus and perinidal anomalous vessel compactness. CS categories included 1 = diffuse nidus, 2 = intermediate nidus, and 3 = compact nidus. RESULTS Forty-eight of 78 children (61.5%) with HHT and brain vascular malformations had a conventional angiogram; 47 (97.9%) angiograms were available. Fifty-four BAVMs were identified in 40 of these 47 children (85.1%). Of 54 BAVMs in children with HHT, CS was 1 in 7 (13%), 2 in 29 (53.7%), and 3 in 18 BAVMs (33.3%) compared with CS of 1 in six (26.1%), 2 in 15 (65.2%), and 3 in 2 BAVMs (8.7%) among 23 previously reported children with sporadic BAVMs, p = 0.045 (Fisher's exact). Seven children with HHT had intracranial hemorrhage: 4 had CS = 3, 1 had CS = 2, and 2 had CS = 1. CONCLUSIONS A range of CSs exists across HHT BAVMs, suggesting it may be an angiographic measure of interest for future studies of BAVM recurrence and hemorrhage risk. Children with HHT may have more compact niduses compared to children with sporadic BAVMs. Additional research should determine whether CS affects hemorrhage risk or post-surgical recurrence risk in HHT-associated BAVMs, which could be used to direct BAVM treatment.
Collapse
Affiliation(s)
- Lauren A Beslow
- Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Penn HHT Center of Excellence and Children's Hospital of Philadelphia Hereditary Hemorrhagic Telangiectasia Program, 3401 Civic Center Boulevard, Philadelphia, 19104, PA, USA.
| | - Arastoo Vossough
- Radiology, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Helen Kim
- Center for Cerebrovascular Research, Anesthesia, University of California, San Francisco, CA, USA
| | - Jeffrey Nelson
- Center for Cerebrovascular Research, Anesthesia, University of California, San Francisco, CA, USA
| | | | - Jeffrey Pollak
- Vascular & Interventional Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Doris D M Lin
- Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Felix Ratjen
- Paediatrics and Paediatric Respiratory Medicine, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Adrienne M Hammill
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children's Hospital Medical Center, and Division of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Steven W Hetts
- Division of Neurointerventional Radiology, University of California, San Francisco, CA, USA
| | - James R Gossage
- Departments of Critical Care Medicine and Pulmonary Medicine, Augusta University, Augusta, GA, USA
| | - Kevin J Whitehead
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, USA
| | - Marie E Faughnan
- Toronto HHT Centre, Department of Medicine, St. Michael's Hospital and Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada
| | - Timo Krings
- Division of Neuroradiology, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Kee TP, Lindgren A, Kiyosue H, Krings T. Dural arteriovenous fistulas involving the superior sagittal and parasagittal sinuses: clinical presentation, imaging characteristics and treatment strategies. AJNR Am J Neuroradiol 2024:ajnr.A8246. [PMID: 38479780 DOI: 10.3174/ajnr.a8246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND PURPOSE Dural arteriovenous fistulas (DAVFs) involving the superior sagittal (SSS) and parasagittal sinuses are often inappropriately classified. We explore the clinical presentations, imaging characteristics and endovascular treatment strategies these two DAVF subtypes. MATERIALS AND METHODS Clinical and imaging data of 19 patients with SSS or parasagittal sinus DAVFs who underwent endovascular treatment in our institution from 2017 and 2022 were retrospectively analyzed. The angiographic findings, endovascular treatment strategies and angiographic outcomes were evaluated and recorded. RESULTS Among these 19 patients, 14 had a parasagittal DAVF, 4 had a SSS DAVF, one patient had both a parasagittal and SSS DAVF. Only one (1/19, 5.26%) patient presented with intracranial haemorrhage (ICH); For the parasagittal DAVF group, most of the shunts were located along the middle third of the SSS (12/15, 80%), on the dura in proximity with the junctional zone between the bridging vein and SSS (15/15, 100%), with ipsilateral cortical venous reflux (CVR) (15/15, 100%). For the SSS DAVF group, all 5 patients had shunting zone along the middle third of the SSS, on the sinus or parasinus wall, with bilateral CVR. Trans-arterial embolization, via the middle meningeal artery (MMA) as the primary route of access, was the primary treatment approach in 95% of cases (19/20). Reflux of embolization material into the SSS was observed in one case (1/5, 20%) of SSS DAVF in which balloon sinus protection was not used during embolization. CONCLUSIONS Our study found that parasagittal DAVFs have shunting point(s) centred on the junctional zone of the bridging vein and the SSS with ipsilateral CVR, while SSS DAVFs have shunting point(s) centred on the sinus or parasinus wall with bilateral CVR. Trans-arterial embolization via the MMA(s) can be used as the primary treatment strategy in most cases. Balloon sinus protection during embolization is not necessary in cases of parasagittal DAVF with occluded or stenosed connection with the SSS but its use should be considered in cases of SSS DAVF with patent sinus. ABBREVIATIONS DAVF, Dural arteriovenous fistula; SSS, Superior sagittal sinus; CVR, Cortical venous reflux; MMA, middle meningeal artery; ICH, Intracranial haemorrhage; STA, Superficial temporal artery; OA, Occipital artery. CFD, Computational fluid dynamics.
Collapse
Affiliation(s)
- T P Kee
- From the Division of Neuroradiology, Joint Department of Medical Imaging and University Medical Imaging Toronto, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada (T.P.K, A.L., T.K.); Department of Neuroradiology, National Neuroscience Institute, Singapore (T.P.K); Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (A.L), Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland (A.L.); Department of Diagnostic Radiology, Kumamoto University Faculty of Medicine, Kumamoto, Japan (H.K.)
| | - A Lindgren
- From the Division of Neuroradiology, Joint Department of Medical Imaging and University Medical Imaging Toronto, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada (T.P.K, A.L., T.K.); Department of Neuroradiology, National Neuroscience Institute, Singapore (T.P.K); Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (A.L), Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland (A.L.); Department of Diagnostic Radiology, Kumamoto University Faculty of Medicine, Kumamoto, Japan (H.K.)
| | - H Kiyosue
- From the Division of Neuroradiology, Joint Department of Medical Imaging and University Medical Imaging Toronto, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada (T.P.K, A.L., T.K.); Department of Neuroradiology, National Neuroscience Institute, Singapore (T.P.K); Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (A.L), Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland (A.L.); Department of Diagnostic Radiology, Kumamoto University Faculty of Medicine, Kumamoto, Japan (H.K.)
| | - T Krings
- From the Division of Neuroradiology, Joint Department of Medical Imaging and University Medical Imaging Toronto, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada (T.P.K, A.L., T.K.); Department of Neuroradiology, National Neuroscience Institute, Singapore (T.P.K); Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (A.L), Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland (A.L.); Department of Diagnostic Radiology, Kumamoto University Faculty of Medicine, Kumamoto, Japan (H.K.)
| |
Collapse
|
4
|
Cheng HC, Lindgren A, Krings T. Subcortical Infarction After Transarterial Embolization of a Borden Type III Transverse Sinus Dural Arteriovenous Fistula. Clin Neuroradiol 2024; 34:275-278. [PMID: 37798543 DOI: 10.1007/s00062-023-01352-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Affiliation(s)
- How-Chung Cheng
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
- Division of Neurosurgery, Department of Surgery, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan, Republic of China.
| | - Antti Lindgren
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Lindgren A, Ahmed SU, Bodani V, Andrade Barazarte H, Agid R, Kee TP, Nicholson P, Hendriks EJ, Krings T. Transarterial Embolization of Dural Arteriovenous Fistulas: Conventional, Pressure Cooker, and Microballoon Catheter Embolization Techniques. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01026. [PMID: 38251902 DOI: 10.1227/ons.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/05/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Dural fistulas are abnormal connections between dural arteries and intracranial veins treated mainly endovascularly in most settings. The aim was to examine a single-institution experience of microballoon catheter transarterial embolization (TAE) of dural arteriovenous fistulas (dAVFs) and compare it with other TAE techniques. METHODS We retrospectively identified all dAVFs treated at our institution between 2017 and 2022 with microballoon, conventional, and pressure cooker TAE. We studied occlusion and retreatment rates, treatment-related complications, and radiation doses. RESULTS During the study period, 66 patients underwent 75 TAE procedures to treat 68 dAVFs: 47 conventional TAE, 14 pressure cooker TAE, and 14 microballoon TAE. Median age of the study population was 63 years with 32% females. The most common dAVF location was the transverse sinus and 20% of dAVFs presented with hemorrhage. At 3-month follow-up, stable complete occlusion of the dAVF was seen in 72% (n = 34) after conventional TAE, 79% (n = 11) after pressure cooker TAE, and 86% (n = 12) after microballoon TAE. Retreatment was required in 19% (n = 9) after conventional TAE, 7% (n = 1) after pressure cooker TAE, and 7% (n = 1) after microballoon TAE. Treatment-related complications occurred in 17% (n =) after conventional TAE, 29% (n = 4) after pressure cooker TAE, and 7% (n = 1) after microballoon TAE. CONCLUSION In our experience, microballoon TAE of dAVFs resulted in better initial and 3-month angiographic outcomes and required less retreatment than conventional TAE. Microballoon TAE also resulted in fewer treatment-related complications than other techniques. In our experience, microballoon TAE is a reliable and safe endovascular technique to treat dAVFs.
Collapse
Affiliation(s)
- Antti Lindgren
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Syed Uzair Ahmed
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Vivek Bodani
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Hugo Andrade Barazarte
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ronit Agid
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tze Phei Kee
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Neuroradiology, National Neuroscience Institute, Singapore, Singapore
| | - Patrick Nicholson
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland
| | - Eef J Hendriks
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Pasarikovski CR, Lynch J, Corrin M, Ku JC, Kumar A, Pereira VM, Krings T, da Costa L, Black SE, Agid R, Yang VX. Carotid stenting for symptomatic carotid artery web: Multicenter experience. Interv Neuroradiol 2024:15910199231226293. [PMID: 38233047 DOI: 10.1177/15910199231226293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE Carotid artery webs are an underappreciated cause of recurrent ischemic stroke, and may represent a significant portion of cryptogenic stroke. Evidence-based guidelines for the management of symptomatic carotid webs do not exist. The goal of this study is to audit our local experience for patients with symptomatic carotid artery webs undergoing carotid stenting as a treatment option, along with describing the hypothesized dynamic physiology of carotid webs. METHODS All patients undergoing stenting for symptomatic carotid artery web at two comprehensive regional stroke centers with high endovascular thrombectomy volume from January 1, 2012 to March 1, 2021 were included. The modified Rankin Scale (mRS) score was used to define functional outcome at 3 months after stenting. RESULTS Fourteen consecutive patients with symptomatic carotid artery webs underwent stenting. Twelve patients were female (86%), with a median age of 54 (IQR, 48-64) years across all patients. Stroke was the qualifying event in 12 (86%) patients and TIA in 2. Eleven patients (11/14, 79%) achieved a mRS score of 0-2 at 90 days, 2 (14%) were mRS 3-5, and one patient was lost to follow-up. The median follow-up was 12 months (IQR, 10-12). There was no recurrent stroke or TIA like symptoms in any patients. CONCLUSIONS Carotid stenting appears to be safe at preventing recurrent stroke/TIA with a median follow-up of 12 months in this retrospective multicenter observational study.
Collapse
Affiliation(s)
| | - Jeremy Lynch
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Michael Corrin
- Biomedical Communications, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Jerry C Ku
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ashish Kumar
- Division of Neurosurgery, Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vitor M Pereira
- Division of Interventional Neuroradiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Leodante da Costa
- Division of Neurosurgery, Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sandra E Black
- Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ronit Agid
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Victor Xd Yang
- Division of Neurosurgery, Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Hendriks EJ, Guardini F, Chung E, Lynch J, Krings T. Delayed Foreshortening and Prolapse of Silk Vista Baby into Superior Cerebellar Artery Aneurysm. World Neurosurg 2024; 181:13-18. [PMID: 37832636 DOI: 10.1016/j.wneu.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Flow diversion has evolved as a minimally invasive treatment for intracranial aneurysms. The Silk Vista Baby (SVB) can be navigated into small cerebral vessels because it can be deployed through a low-profile microcatheter. METHODS We report on treating a patient in his 70s with an unruptured fusiform right superior cerebellar artery aneurysm using an SVB. RESULTS Significant foreshortening of the device was noted during the initial procedure; however, the position was satisfactory with good apposition and clearance of the aneurysm neck. A stable position of the SVB on 1-day and 2-month postprocedural computed tomography angiography was also demonstrated. Subsequently, a 6-month follow-up computed tomography angiography detected delayed foreshortening and prolapse of the SVB into the aneurysm, for which an additional SVB was placed in a second procedure. There were no complications and the patient remained clinically well. CONCLUSIONS Although the intraoperative foreshortening was not unexpected, the delayed postprocedural behavior of proximal foreshortening and subsequent prolapse of the SVB into the aneurysm have not been previously described. We would like to share this for awareness in this technical note.
Collapse
Affiliation(s)
- Eef J Hendriks
- Division of Neuroradiology, University Medical Imaging Toronto & Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
| | - Felipe Guardini
- Division of Neuroradiology, University Medical Imaging Toronto & Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Emily Chung
- Division of Neuroradiology, University Medical Imaging Toronto & Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jeremy Lynch
- Division of Neuroradiology, University Medical Imaging Toronto & Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, University Medical Imaging Toronto & Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Alsufayan R, Hess C, Krings T. Monoclonal Antibodies: What the Diagnostic Neuroradiologist Needs to Know. AJNR Am J Neuroradiol 2023; 44:1358-1366. [PMID: 37591772 PMCID: PMC10714862 DOI: 10.3174/ajnr.a7974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023]
Abstract
Monoclonal antibodies have become increasingly popular as novel therapeutics against a variety of diseases due to their specificity, affinity, and serum stability. Due to the nearly infinite repertoire of monoclonal antibodies, their therapeutic use is rapidly expanding, revolutionizing disease course and management, and what is now considered experimental therapy may soon become approved practice. Therefore, it is important for radiologists, neuroradiologists, and neurologists to be aware of these drugs and their possible different imaging-related manifestations, including expected and adverse effects of these novel drugs. Herein, we review the most commonly used monoclonal antibody-targeted therapeutic agents, their mechanism of action, clinical applications, and major adverse events with a focus on neurologic and neurographic effects and discuss differential considerations, to assist in the diagnosis of these conditions.
Collapse
Affiliation(s)
- R Alsufayan
- From the Division of Neuroradiology, Department of Medical Imaging (R.A., T.K.), University of Toronto, Toronto Western Hospital, University Health Network and University Medical Imaging, Toronto, Ontario, Canada
- Department of Diagnostic Imaging (R.A.), Peterborough Regional Health Centre, Peterborough, Ontario, Canada
| | - C Hess
- Deartment of Radiology and Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, California
| | - T Krings
- From the Division of Neuroradiology, Department of Medical Imaging (R.A., T.K.), University of Toronto, Toronto Western Hospital, University Health Network and University Medical Imaging, Toronto, Ontario, Canada
- Division of Neurosurgery (T.K.), Sprott Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
9
|
Cheng HC, Faughnan ME, terBrugge KG, Liu HM, Krings T. Prevalence and Characteristics of Intracranial Aneurysms in Hereditary Hemorrhagic Telangiectasia. AJNR Am J Neuroradiol 2023; 44:1367-1372. [PMID: 38050014 PMCID: PMC10714847 DOI: 10.3174/ajnr.a8058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/06/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND AND PURPOSE The association between hereditary hemorrhagic telangiectasia and intracranial aneurysms remains controversial. This study evaluated the prevalence and characteristics of intracranial aneurysms in patients with hereditary hemorrhagic telangiectasia with brain vascular malformations. MATERIALS AND METHODS Between 2007 and 2021, patients enrolled in the Brain Vascular Malformation Consortium with definite hereditary hemorrhagic telangiectasia, the presence of brain vascular malformations, and available angiographic studies of the brain were retrospectively reviewed. Angiographic features of intracranial aneurysms and their relationship to coexisting brain vascular malformations were analyzed. We also examined the association between baseline clinical features and the presence of intracranial aneurysms. RESULTS One hundred eighty patients were included. A total of 14 intracranial aneurysms were found in 9 (5%) patients, and 4 intracranial aneurysms were considered flow-related aneurysms. Patients with intracranial aneurysms were significantly older than patients without intracranial aneurysms (mean, 48.1 [SD, 18.2] years versus 33.5 [SD, 21.0] years; P = .042). If we excluded flow-related intracranial aneurysms, the prevalence of intracranial aneurysms was 3.3%. All intracranial aneurysms were in the anterior circulation, were unruptured, and had an average maximal diameter of 3.9 (SD, 1.5) mm. No intracranial aneurysms were found in pediatric patients with hereditary hemorrhagic telangiectasia. No statistically significant correlation was observed among other baseline demographics, hereditary hemorrhagic telangiectasia features, and the presence of intracranial aneurysms. CONCLUSIONS The prevalence of intracranial aneurysms in this large cohort study is comparable with that in the general population and might be increased slightly due to hemodynamic factors associated with shunting brain vascular malformations.
Collapse
Affiliation(s)
- How-Chung Cheng
- From the Division of Neuroradiology (H.-C.C., K.G.t., T.K.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery (H.-C.C.), Department of Surgery, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Marie E Faughnan
- Toronto HHT Centre (M.E.F.), St. Michael's Hospital and Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Division of Respirology (M.E.F.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karel G terBrugge
- From the Division of Neuroradiology (H.-C.C., K.G.t., T.K.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Hon-Man Liu
- Department of Medical Imaging (H.-M.L.), Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Timo Krings
- From the Division of Neuroradiology (H.-C.C., K.G.t., T.K.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
10
|
O'Reilly ST, Hendriks EJ, Itsekson Z, Alshahrani R, Chung E, Radovanovic I, Agid R, Nicholson P, Krings T. Utilisation of the Scepter Mini dual-lumen balloon - An illustrative series. Interv Neuroradiol 2023:15910199231216759. [PMID: 38018015 DOI: 10.1177/15910199231216759] [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: 11/30/2023] Open
Abstract
BACKGROUND Dual-lumen balloon microcatheters can aid in the safety and efficacy of endovascular embolisation of cerebrospinal vascular malformations. The Scepter Mini dual-lumen balloon is a novel device with a smaller profile than previous balloon microcatheters, opening up new indications not only in the treatment of cerebrospinal malformations but in various other neurovascular therapeutic and diagnostic scenarios. METHODS Following institutional ethics review board approval, a retrospective review of our prospectively maintained database of cases employing the Scepter Mini dual-lumen microballoon catheter was conducted. Five cases in particular were highlighted, demonstrating utilisation of this device, which may be of interest to the Neurointerventionalist. Patient demographics, procedure details, complications and clinical outcome data were reviewed. RESULTS Five cases employing the Scepter Mini dual-lumen microballoon catheter are presented; trans-arterial embolisation of cerebral AVM, pre-operative tumour embolisation, diagnostic angiography, trans-venous embolisation of cerebral AVM and trans-arterial embolisation of DAVF. No intraprocedural complications were recorded, one patient had a delayed haemorrhage. CONCLUSION Potential utilisation of the Scepter Mini lies not only in the trans-arterial embolisation of cerebrospinal vascular malformations, but in a range of other diagnostic and therapeutic indications as demonstrated.
Collapse
Affiliation(s)
- Sean Thomas O'Reilly
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Neuroradiology, Royal Victoria Hospital, Belfast, County Antrim, UK
| | - Eef Jacobus Hendriks
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ze'ev Itsekson
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Rabab Alshahrani
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Emily Chung
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ivan Radovanovic
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ronit Agid
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Jung Y, Lindgren A, Ahmed SU, Radovanovic I, Krings T, Andrade-Barazarte H. Intraoperative intraarterial indocyanine green video-angiography for disconnection of a perimedullary arteriovenous fistula: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23405. [PMID: 38011693 PMCID: PMC10684059 DOI: 10.3171/case23405] [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: 07/23/2023] [Accepted: 09/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Intraarterial (IA) indocyanine green (ICG) angiography is an intraoperative imaging technique offering special and temporal characterization of vascular lesions with very fast dye clearance. The authors' aim is to demonstrate the use of IA ICG angiography to aid in the surgical treatment of a perimedullary thoracic arteriovenous fistula (AVF) in a hybrid operating room (OR). OBSERVATIONS A 31-year-old woman with a known history of spinal AVF presented with 6 weeks of lower-extremity weakness, gait imbalance, and bowel/bladder dysfunction. Magnetic resonance imaging revealed an extensive series of flow voids across the thoracic spine, most notably at T11-12. After partial embolization, she was taken for surgical disconnection in a hybrid OR. Intraoperative spinal digital subtraction angiography was performed to identify feeding vessels. When the target arteries were catheterized, 0.05 mg of ICG in 2 mL of saline was injected, and the ICG flow in each artery was recorded using the microscope. With an improved surgical understanding of the contributing feeding arteries, the authors achieved complete in situ disconnection of the AVF. LESSONS IA ICG angiography can be used in hybrid OR settings to illustrate the vascular anatomy of multifeeder perimedullary AVFs and confirm its postoperative disconnection with a fast dye clearance.
Collapse
Affiliation(s)
- Youngkyung Jung
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; and
| | - Antti Lindgren
- Joint Department of Medical Imaging, Division of Neuroradiology, University of Toronto, Toronto, Ontario, Canada
| | - Syed Uzair Ahmed
- Joint Department of Medical Imaging, Division of Neuroradiology, University of Toronto, Toronto, Ontario, Canada
| | - Ivan Radovanovic
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; and
| | - Timo Krings
- Joint Department of Medical Imaging, Division of Neuroradiology, University of Toronto, Toronto, Ontario, Canada
| | - Hugo Andrade-Barazarte
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; and
| |
Collapse
|
12
|
Huisman TAGM, Atlas SW, Berenstein A, Krings T, Ter Brugge K, Yaşargil MG. Professor Antonios (Anton) Valavanis, MD. AJNR Am J Neuroradiol 2023; 44:E42-E44. [PMID: 37827716 PMCID: PMC10631526 DOI: 10.3174/ajnr.a8010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
|
13
|
Handzic A, Ahmed SU, Mosimann P, Krings T, Daniel S, Margolin E. Carotid Cavernous Sinus Fistula Supplied by an Embryological Variant of the Ophthalmic Artery Causing Posterior Ischemic Optic Neuropathy and Ophthalmoplegia. J Neuroophthalmol 2023:00041327-990000000-00482. [PMID: 37824283 DOI: 10.1097/wno.0000000000002010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Affiliation(s)
- Armin Handzic
- Faculty of Medicine (AH, SD, EM), Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Faculty of Medicine (SUA, PM, TK), Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto, Canada; and Faculty of Medicine (EM), Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
| | | | | | | | | | | |
Collapse
|
14
|
Ellenbogen Y, Hendriks EJ, Karadimas S, O'Reilly S, Itsekzon Hayosh Z, Alshahrani R, Agid R, Schaafsma J, Krings T, Nicholson P. Use of the neuroform atlas for stenting of intracranial atherosclerotic disease: Clinical and angiographic outcomes. Interv Neuroradiol 2023:15910199231195134. [PMID: 37817560 DOI: 10.1177/15910199231195134] [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: 10/12/2023] Open
Abstract
BACKGROUND Intracranial atherosclerotic disease (ICAD) is a potential cause of ischemic stroke. Treatment of ICAD can include intracranial stenting. There are specifically designed stents for this use-case; however, less is known about the off-label use of the Neuroform Atlas stent. In this study, we describe the outcomes of the Neuroform Atlas stent for treatment of ICAD. METHODS Adult patients with symptomatic ICAD failing best medical treatment undergoing elective intracranial stenting using the Neuroform Atlas stent between November 2018 and March 2021 were included. Patient demographics, procedure-related details and clinical and imaging outcomes were analyzed. RESULTS Eighteen patients met the inclusion criteria, with a mean follow-up duration of 9.6 ± 6.8 (standard deviation) months. There were two procedure-related mortalities (one massive intracranial hemorrhage and one groin site complication with sepsis). Fifteen patients were alive at the 6-month follow-up, all with satisfactory stent patency on follow-up imaging without any new ischemic events. Modified Rankin Scale at latest follow-up was 1.9 (interquartile range 5). CONCLUSION In this single-center consecutive series, intracranial stenting with the Neuroform Atlas stent was a safe and effective treatment for symptomatic ICAD patients failing best medical management.
Collapse
Affiliation(s)
- Yosef Ellenbogen
- Division of Neurosurgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Eef J Hendriks
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Spyros Karadimas
- Division of Neurosurgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Sean O'Reilly
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Zeev Itsekzon Hayosh
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Rabab Alshahrani
- Division of Neurosurgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Ronit Agid
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Joanna Schaafsma
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Schmolling ÁH, Bodani V, Jaroenngarmsamer T, Andrade-Barazarte H, Radovanovic I, Krings T. Anatomical considerations regarding a high-flow arteriovenous fistula below the conus medullaris in a patient with hereditary hemorrhagic telangiectasia: Case report. Interv Neuroradiol 2023:15910199231196458. [PMID: 37621120 DOI: 10.1177/15910199231196458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Cauda equina radicular arteriovenous fistulas are rare "low flow" shunting lesions characterized by direct communication between the radicular artery and vein of a cauda equina nerve root. None have been associated with hereditary hemorrhagic telangiectasia and a high-flow cauda equina radicular arteriovenous fistula has never been reported. We present a unique case of a high-flow cauda equina radicular arteriovenous fistula in a patient with hereditary hemorrhagic telangiectasia. Marked flow-induced vascular remodeling posed significant diagnostic and therapeutic challenges which will be highlighted in this report. CLINICAL PRESENTATION A 39-year-old female with genetically confirmed hereditary hemorrhagic telangiectasia presented with progressive thoracic myelopathy secondary to a high-flow single-hole arteriovenous fistula below the conus. The feeding artery, arising from the anterior spinal artery, and draining vein had a paramedian course, favoring the diagnosis of a cauda equina radicular arteriovenous fistula (supplied by a proximal radicular artery) over a filum terminale arteriovenous fistula. Transarterial embolization was attempted but significant elongation and tortuosity of the anterior spinal artery precluded microcatheter access to the fistulous point. Surgical disconnection was successfully performed. The intraoperative findings supported the diagnosis of cauda equina radicular arteriovenous fistula. Delayed neurologic deterioration secondary to overshooting venous thrombosis was observed. She recovered after the initiation of therapeutic anticoagulation. CONCLUSION To the best of our knowledge, we hereby report the first high-flow cauda equina radicular arteriovenous fistula. The accurate differentiation of cauda equina radicular arteriovenous fistula from filum terminale arteriovenous fistulas, while challenging, is important to avoid treatment-related complications. Careful preoperative planning, the use of specialized endovascular and surgical techniques, and meticulous postoperative care can ensure the safe and complete disconnection of high-flow cauda equina radicular arteriovenous fistulas.
Collapse
Affiliation(s)
- Ángela H Schmolling
- Division of Neuroradiology, University Medical Imaging Toronto, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Departamento de Neurorradiología Intervencionista, Servicio de Radiodiagnóstico, Hospital Clínico San Carlos, Madrid, Spain
| | - Vivek Bodani
- Division of Neuroradiology, University Medical Imaging Toronto, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Tanaporn Jaroenngarmsamer
- Division of Neuroradiology, University Medical Imaging Toronto, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Hugo Andrade-Barazarte
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ivan Radovanovic
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, University Medical Imaging Toronto, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
16
|
Hsu CCT, Fomin I, Wray B, Brideaux A, Lyons D, Jaya Kumar M, Watkins T, Haacke EM, Krings T. Susceptibility weighted imaging for qualitative grading of persistent arteriovenous shunting in deep-seated arteriovenous malformations after stereotactic radiation surgery. Neuroradiol J 2023; 36:414-420. [PMID: 36411595 PMCID: PMC10588604 DOI: 10.1177/19714009221140536] [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: 07/20/2023] Open
Abstract
BACKGROUND AND PURPOSE To investigate Susceptibility Weighted Imaging (SWI) signal changes in the draining vein of deep-seated arterio-venous malformations (AVMs) following stereotactic radiosurgery (SRS). METHODS AND MATERIALS This is a retrospective study of 32 patients with deep-seated AVMs who were treated with SRS. Pre-SRS treatment and post-SRS treatment MRI were performed at 6, 12, and 24-month intervals. Deep-seated AVMs were classified based on their anatomical location and venous drainage pattern. AVM nidal volume (cm3) was estimated using the ABC/2 method. AV shunting of the AVM draining veins were graded according to its SWI signal intensity: hyperintense (grade III), mixed signal intensity (grade II), hypointense (grade I) and absent (grade 0). Conventional time-of-flight (TOF)-MRA and contrast enhanced (CE)-MRA sequences were performed to document the patency of the vein. RESULTS Pre-SRS treatment AVM draining veins were either grade III 18/32 (56%) or grade II 14/32 (44%). Using mixed effects analysis, we demonstrate that each month following the SRS treatment nidal volumes decreased at the rate of 0.51 cm3/per month (CI -0.61 to (-0.40)) p =.00. Following the treatment, there was a clinically significant relationship between the signal and nidal volume: signal 0 corresponded with average nidal volume of 1.81 cm3 (CI 1.40-2.21), signal 1 with nidal volume of 2.06 cm3 (CI 1.69-2.44), signal 2 with nidal volume 2.73 cm3 (CI 2.35-3.11) and signal 3 with nidal volume 3.13 cm3 (CI 2.70-3.56) p = .00. CONCLUSION Post-SRS AVM draining veins shows a stepwise regression of the SWI signal grades which can be reliably used as a surrogate to monitor the reduction of AV shunting.
Collapse
Affiliation(s)
- Charlie Chia-Tsong Hsu
- Division of Neuroradiology, Department of Medical Imaging, Gold Coast University Hospital, Southport, QLD, Australia
- Division of Neuroradiology, Lumus Imaging, Varsity Lakes, QLD, Australia
| | - Igor Fomin
- Division of Neuroradiology, Department of Medical Imaging, Gold Coast University Hospital, Southport, QLD, Australia
| | - Bradley Wray
- Department of Medical Imaging, Queensland Xray, Greenslopes Private Hospital, Greenslopes, QLD, Australia
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Adam Brideaux
- Division of Neuroradiology, Department of Medical Imaging, Gold Coast University Hospital, Southport, QLD, Australia
| | - Duncan Lyons
- Division of Neuroradiology, Department of Medical Imaging, Gold Coast University Hospital, Southport, QLD, Australia
| | - Mahendrah Jaya Kumar
- Department of Medical Imaging, Queensland Xray, Greenslopes Private Hospital, Greenslopes, QLD, Australia
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Trevor Watkins
- Department of Medical Imaging, Queensland Xray, Greenslopes Private Hospital, Greenslopes, QLD, Australia
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - E Mark Haacke
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, ON, Canada
| | - Timo Krings
- Department of Radiology, Wayne State University, Detroit, MI, USA
| |
Collapse
|
17
|
van Niftrik CHB, Sebök M, Nicholson P, Olijnyk L, Thurner P, Venkatraghavan L, Schaafsma J, Radovanovic I, Fisher JA, Krings T, Kulcsár Z, Tymianski M, Regli L, Mikulis DJ, Fierstra J. A dual-center validation of the PIRAMD scoring system for assessing the severity of ischemic Moyamoya disease. Quant Imaging Med Surg 2023; 13:4618-4632. [PMID: 37456328 PMCID: PMC10347338 DOI: 10.21037/qims-22-1062] [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: 10/02/2022] [Accepted: 03/28/2023] [Indexed: 07/18/2023]
Abstract
Background Prior Infarcts, Reactivity, and Angiography in Moyamoya Disease (PIRAMD) is a recently proposed imaging-based scoring system that incorporates the severity of disease and its impact on parenchymal hemodynamics in order to better support clinical management and evaluate response to intervention. In particular, PIRAMD may have merit in identifying symptomatic patients that may benefit most from revascularization. Our aim was to validate the PIRAMD scoring system. Methods Patients with ischemic Moyamoya disease, who underwent catheter angiographic [modified Suzuki Score (mSS) and collateralization status], morphological MRI and a parenchymal hemodynamic evaluation with blood oxygenation-level dependent cerebrovascular reactivity (BOLD-CVR) at two transatlantic centers, were retrospectively included. The primary outcome was the presence of neurological symptoms. The diagnostic capacity of each PIRAMD feature alone was evaluated, as well as combined and the inter-institutional differences of each parameter were evaluated. Results Seventy-two hemispheres of 38 patients were considered for analysis, of which 39 (54%) were classified as symptomatic. The presence of a prior infarct had the highest odds ratio [odds ratio (OR) =24; 95% CI: 6.7-87.2] for having neurological symptoms, followed by impaired CVR (OR =17; 95% CI: 5-62). No inter-institutional differences in the odds ratios or area under the curve (AUC) were found for any study parameter. The PIRAMD score had an AUC of 0.88 (95% CI: 0.80-0.96) with a similar AUC for the PIRAMD grading score. Conclusions Our multicentric validation of the recently published PIRAMD scoring system was highly effective in rating the severity of ischemic Moyamoya disease with excellent inter-institutional agreement. Future studies should investigate the prognostic value of this novel imaging-based score in symptomatic patients with Moyamoya disease.
Collapse
Affiliation(s)
- Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Patrick Nicholson
- Division of Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Leonardo Olijnyk
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Patrick Thurner
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lashmi Venkatraghavan
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Joanna Schaafsma
- Department of Neurology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Ivan Radovanovic
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Joseph A. Fisher
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Timo Krings
- Division of Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Zsolt Kulcsár
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Tymianski
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - David J. Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
18
|
Nagendra S, Ahmed SU, Krings T. Spontaneous obliteration of a spinal perimedullary fistula. Interv Neuroradiol 2023:15910199231184522. [PMID: 37385949 DOI: 10.1177/15910199231184522] [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: 07/01/2023] Open
Abstract
We herewith report a young patient who had an incidental spinal vascular malformation of the cervicomedullary junction discovered during a work-up for anosmia. Angiography demonstrated a perimedullary spinal arteriovenous fistula with supply from lateral spinal arteries arising from bilateral V3 level segmental arteries. It was decided to manage the patient conservatively with magnetic resonance imaging monitored biannually. On a recent follow-up magnetic resonance, nearly 10 years later, we noted a subtle change in caliber and imaging characteristics at the posterior margin of the cervical medullary junction. Repeat digital-subtraction angiography showed no evidence of early venous filling from the previously involved branches. Microcatheter exploration of the right lateral spinal artery confirmed spontaneous occlusion of the spinal perimedullary arteriovenous fistula, without any persistent shunting. Spontaneous resolution of a spinal vascular malformation is rare; this case demonstrates the dynamic nature of shunting vascular malformations and that spontaneous obliteration of arteriovenous shunts is possible.
Collapse
Affiliation(s)
- Shashank Nagendra
- Division of Neuroradiology, University Medical Imaging Toronto and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Syed Uzair Ahmed
- Division of Neuroradiology, University Medical Imaging Toronto and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Timo Krings
- Division of Neuroradiology, University Medical Imaging Toronto and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| |
Collapse
|
19
|
Handzic A, Krings T, Margolin E. Isolated Papilledema Due to Dural Sinus Thrombosis Occluding Both Internal Jugular Veins: Challenging Current Concepts. J Neuroophthalmol 2023; Publish Ahead of Print:00041327-990000000-00379. [PMID: 37335623 DOI: 10.1097/wno.0000000000001913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Affiliation(s)
- Armin Handzic
- Faculty of Medicine (AH, EM), Department of Ophthalmology and Vision Sciences, and Faculty of Medicine (EM), Division of Neurology, Department of Medicine, and Faculty of Medicine (TK), Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto, Canada
| | | | | |
Collapse
|
20
|
Hainc N, Alcaide-Leon P, Willinsky RA, Krings T, Nicholson P. Periventricular Nodular Heterotopia (PNH) associated with a "transmantle band sign" in epilepsy patients. Epilepsia 2023. [PMID: 37014283 DOI: 10.1111/epi.17604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE Previous studies using advanced MRI techniques have documented abnormal transmantle bands connecting ectopic nodules to overlying cortex in patients with periventricular nodular heterotopia (PNH). We describe a similar finding using conventional MRI techniques. METHODS Patients were identified by means of a full-text search of radiological reports. All scanning was performed using conventional sequences at 3T. Scans were reviewed by three neuroradiologists, and we characterized imaging features based on type of PNH and cortical irregularities associated with the transmantle band. RESULTS A total 57 PNH patients were reviewed, of whom 41 demonstrated a 'transmantle band' connecting the nodule to the overlying cortex. One or more periventricular heterotopic nodule was present in all 41 patients - this was bilateral in 29/41 (71%) and unilateral in the remaining 29%. In many cases there was more than one such band, and in some cases this band was nodular. In 19 of the cases, the cortex which the band connected to was abnormal, showing thinning in 4 cases, thickening in 5 cases, and polymicrogyria in another 10. SIGNIFICANCE The transmantle band can frequently be seen in both unilateral and bilateral cases of periventricular nodular heterotopia and can be visualized with conventional 3T MRI sequences. It highlights the underlying neuronal migration issues at play in the pathogenesis of this disorder, but it's underlying role in the complex, patient-specific epileptogenic networks in this cohort has yet to be determined and warrants further investigation.
Collapse
Affiliation(s)
- Nicolin Hainc
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Paula Alcaide-Leon
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert A Willinsky
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
21
|
Kilian A, Latino GA, White AJ, Ratjen F, McDonald J, Whitehead KJ, Gossage JR, Krings T, Lawton MT, Kim H, Faughnan ME. Comparing Characteristics and Treatment of Brain Vascular Malformations in Children and Adults with HHT. J Clin Med 2023; 12:2704. [PMID: 37048789 PMCID: PMC10094792 DOI: 10.3390/jcm12072704] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant disease characterized by the development of vascular malformations (VMs) in organs such as the brain and lungs, as well as telangiectases on mucosal surfaces. Prophylactic treatment of organ VMs may prevent potential complications, such as hemorrhage. However, brain VM treatment-surgical resection, embolization, and/or radiosurgery-is not recommended for all patients due to the associated risks. Given the scarcity of data regarding HHT-related brain VM presentation and treatment trends in pediatric patients, we aim to describe the clinical presentations and the patterns of treatment of HHT-related brain VMs in a pediatric cohort, and compare pediatric trends to those of adults. Demographic and clinical data were analyzed in 114 pediatric patients with HHT-related brain VMs and compared with a cohort of 253 adult patients enrolled in the multicenter Brain Vascular Malformation Consortium HHT Project. Our data demonstrated that a higher proportion of pediatric patients with HHT-related brain VMs were symptomatic at presentation (p = 0.004). Moreover, a higher proportion of pediatric patients presented with intracranial hemorrhage (p < 0.001) and seizure (p = 0.002) compared to adult patients. Surgical resection was the most common brain VM treatment modality in both children and adults. We conclude that pediatric patients may be more likely to present with symptoms and complications from brain VMs, supporting the case for screening for brain VMs in children with HHT.
Collapse
Affiliation(s)
- Alexandra Kilian
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Toronto HHT Centre, St. Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON M5B 1W8, Canada
| | - Giuseppe A. Latino
- Toronto HHT Centre, St. Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON M5B 1W8, Canada
- Department of Pediatrics, North York General Hospital, University of Toronto, Toronto, ON M2K 1E1, Canada
| | - Andrew J. White
- Department of Pediatrics, St Louis University, St. Louis, MO 63103, USA
| | - Felix Ratjen
- Division of Respiratory Medicine and Translational Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Jamie McDonald
- Department of Pathology, University of Utah, Salt Lake City, UT 84132, USA
| | - Kevin J. Whitehead
- Department of Medicine, Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT 84132, USA
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT 84132, USA
| | - James R. Gossage
- Department of Medicine, Augusta University, Augusta, GA 30912, USA
| | - Timo Krings
- Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, ON M5T 2S8, Canada
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ 85013, USA
| | - Helen Kim
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA 94110, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA 94143, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
| | - Marie E. Faughnan
- Toronto HHT Centre, St. Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON M5B 1W8, Canada
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
| | | |
Collapse
|
22
|
Hale AT, Savage C, Parr MS, Hedaya A, Saccomano B, Tsema GB, Hafeez M, Tanweer O, Kan P, Solomon L, Deloison B, Meila D, Blount JP, Johnston JM, Rocque BG, Rozzelle CJ, Bhatia K, Muthusami P, Krings T, Jones J. 807 Outcomes of Endovascular Embolization for Vein of Galen Malformations: An Individual Participant Data Meta-Analysis. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_807] [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: 03/17/2023] Open
|
23
|
Hsu CCT, Krings T. Symptomatic Developmental Venous Anomaly: State-of-the-Art Review on Genetics, Pathophysiology, and Imaging Approach to Diagnosis. AJNR Am J Neuroradiol 2023; 44:498-504. [PMID: 36997285 PMCID: PMC10171382 DOI: 10.3174/ajnr.a7829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/23/2023] [Indexed: 04/01/2023]
Abstract
Developmental venous anomalies (DVAs) are the most common slow-flow venous malformation in the brain. Most DVAs are benign. Uncommonly, DVAs can become symptomatic, leading to a variety of different pathologies. DVAs can vary significantly in size, location, and angioarchitecture, and imaging evaluation of symptomatic developmental venous anomalies requires a systematic approach. In this review, we aimed to provide neuroradiologists with a succinct overview of the genetics and categorization of symptomatic DVAs based on the pathogenesis, which forms the foundation for a tailored neuroimaging approach to assist in diagnosis and management.
Collapse
Affiliation(s)
- C C-T Hsu
- From the Division of Neuroradiology (C.C.-T.H.), Department of Medical Imaging, Gold Coast University Hospital, Southport, Queensland, Australia
- Division of Neuroradiology (C.C.-T.H.), Lumus Imaging, Varsity Lakes, Queensland, Australia
| | - T Krings
- Division of Neuroradiology (T.K.), Department of Medical Imaging, Toronto Western Hospital; University Medical Imaging Toronto and University of Toronto, Ontario, Canada
| |
Collapse
|
24
|
Hanel RA, Cortez GM, Lopes DK, Nelson PK, Siddiqui AH, Jabbour P, Mendes Pereira V, István IS, Zaidat OO, Bettegowda C, Colby GP, Mokin M, Schirmer CM, Hellinger FR, Given C, Krings T, Taussky P, Toth G, Fraser JF, Chen M, Priest R, Kan P, Fiorella D, Frei D, Aagaard-Kienitz B, Diaz O, Malek AM, Cawley CM, Puri AS, Kallmes DF. Prospective study on embolization of intracranial aneurysms with the pipeline device (PREMIER study): 3-year results with the application of a flow diverter specific occlusion classification. J Neurointerv Surg 2023; 15:248-254. [PMID: 35292570 PMCID: PMC9985759 DOI: 10.1136/neurintsurg-2021-018501] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/06/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The pipeline embolization device (PED; Medtronic) has presented as a safe and efficacious treatment for small- and medium-sized intracranial aneurysms. Independently adjudicated long-term results of the device in treating these lesions are still indeterminate. We present 3-year results, with additional application of a flow diverter specific occlusion scale. METHODS PREMIER (prospective study on embolization of intracranial aneurysms with pipeline embolization device) is a prospective, single-arm trial. Inclusion criteria were patients with unruptured wide-necked intracranial aneurysms ≤12 mm. Primary effectiveness (complete aneurysm occlusion) and safety (major neurologic event) endpoints were independently monitored and adjudicated. RESULTS As per the protocol, of 141 patients treated with a PED, 25 (17.7%) required angiographic follow-up after the first year due to incomplete aneurysm occlusion. According to the Core Radiology Laboratory review, three (12%) of these patients progressed to complete occlusion, with an overall rate of complete aneurysm occlusion at 3 years of 83.3% (115/138). Further angiographic evaluation using the modified Cekirge-Saatci classification demonstrated that complete occlusion, neck residual, or aneurysm size reduction occurred in 97.1%. The overall combined safety endpoint at 3 years was 2.8% (4/141), with only one non-debilitating major event occurring after the first year. There was one case of aneurysm recurrence but no cases of delayed rupture in this series. CONCLUSIONS The PED device presents as a safe and effective modality in treating small- and medium-sized intracranial aneurysms. The application of a flow diverter specific occlusion classification attested the long-term durability with higher rate of successful aneurysm occlusion and no documented aneurysm rupture. TRIAL REGISTRATION NCT02186561.
Collapse
Affiliation(s)
- Ricardo A Hanel
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Gustavo M Cortez
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | | | - Peter Kim Nelson
- Interventional Radiology, NYU Langone Medical Center, New York, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Istvan Szikora István
- Department of Neuroradiology, National Institute of Neurosciences, Budapest, Hungary
| | - Osama O Zaidat
- Neuroscience Institute, Mercy Health Saint Vincent Medical Center, Toledo, Ohio, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Geoffrey P Colby
- Department Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Maxim Mokin
- Department of Neurosurgery, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Clemens M Schirmer
- Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Frank R Hellinger
- Department of Radiology, Florida Hospital Neuroscience Institute, Winter Park, Florida, USA
| | - Curtis Given
- Department of Radiology, Baptist Health Lexington, Lexington, Kentucky, USA
| | - Timo Krings
- Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Philipp Taussky
- Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Gabor Toth
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Justin F Fraser
- Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Michael Chen
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ryan Priest
- Charles T Dotter Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - David Fiorella
- Department of Neurosurgery, Cerebrovascular Center, Stony Brook University, Stony Brook, New York, USA
| | - Donald Frei
- Department of Neuroradiology, Swedish Medical Center, Englewood, Colorado, USA
| | - Beverly Aagaard-Kienitz
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Orlando Diaz
- Cerebrovascular Center, Houston Methodist Research Institute, Houston, Texas, USA
| | - Adel M Malek
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - C Michael Cawley
- Department of Neurointerventional Radiology and Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
25
|
Lindgren A, Saini J, Krings T. Concomitant Rupture of an Intracranial Aneurysm and a Dural Arteriovenous Fistula: Clinical Image. World Neurosurg 2023; 171:137-138. [PMID: 36603650 DOI: 10.1016/j.wneu.2022.12.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023]
Abstract
A patient in his 50s presented with postcoital severe headache. Computed tomography revealed a subarachnoid hemorrhage but also a subdural hematoma at the left convexity. Computed tomography angiography revealed a large irregular anterior communicating artery aneurysm but also cortical serpiginous vessels suggestive of a vascular malformation adjacent to the subdural hematoma in the left convexity. Digital subtraction angiography confirmed the ruptured aneurysm but also revealed a Borden 3 type dural arteriovenous fistula on the left convexity. The fistula had arterial supply mostly from middle meningeal artery branches and venous drainage directly to a left cortical vein adjacent to superior sagittal sinus. Ruptured aneurysm was treated with coiling. The ruptured fistula was treated in the same session with transarterial Onyx embolization. The patient had a favorable outcome. Our case is an important reminder for all clinicians treating patients with intracranial hemorrhages on the necessity of fully reviewing all available preoperative imaging.
Collapse
Affiliation(s)
- Antti Lindgren
- Division of Interventional Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; School of Medicine, Faculty of Health Sciences Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Jasleen Saini
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Interventional Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
26
|
O’Reilly ST, Krings T. Medial Tentorial Meningeal Supply from the Collicular Artery : Anatomy and Endovascular Implications. Clin Neuroradiol 2023; 33:555-559. [PMID: 36629869 PMCID: PMC9838289 DOI: 10.1007/s00062-022-01250-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/24/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Sean Thomas O’Reilly
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, 399 Bathurst St, ON M5T 2S8 Toronto, Ontario Canada ,Department of Neuroradiology, Royal Victoria Hospital, Belfast, County Antrim UK
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, 399 Bathurst St, ON M5T 2S8 Toronto, Ontario Canada ,Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada
| |
Collapse
|
27
|
Itsekzon-Hayosh Z, Hendriks EJ, O'Reilly ST, Al Shahrani R, Agid R, Nicholson P, Terbrugge K, Radovanovic I, Andrade H, Schaafsma JD, Krings T. Thoracolumbar spinal dural arteriovenous fistulae present with longer arteriovenous transit compared to cranial and cervical dural fistulae. Interv Neuroradiol 2023:15910199221149096. [PMID: 36604849 DOI: 10.1177/15910199221149096] [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: 01/07/2023] Open
Abstract
BACKGROUND Thoraco-lumbar spinal dural arteriovenous fistulae represent a rare subset of central nervous system vascular malformations. One of the unique features of spinal dural arteriovenous fistulae is their extremely low propensity to cause hemorrhage (either parenchymal or subarachnoid), with a distinct clinical presentation of myelopathy secondary to spinal venous congestion. The exact mechanism for this unique presentation is still unclear. METHODS Following institutional review board approval, we retrospectively analyzed our prospectively maintained database of spinal dural arteriovenous fistulae and cranial (cr) DAVF cases presenting between 2008 and 2021. For all cases, angiograms were reviewed and arteriovenous transit times were calculated. Patient demographics, angiographic features, and clinical and radiological outcomes were assessed. RESULTS In total, 66 patients presenting with confirmed thoracolumbar spinal dural arteriovenous fistulaes were identified and compared to patients presenting with cervical spinal dural arteriovenous fistulaes (n = 10), ruptured crDAVFs (n = 32) and unruptured crDAVFs (n = 20). Mean age in the target group was 66 ± 13 versus 57-62 in the other groups, p < 0.05 on one-way analysis of variance; with 80% males versus 50%-65% in other groups. Mean arteriovenous transit time in the thoracolumbar group measured 1.98 s ± 0.96 versus 0.25-0.5 s range in other groups (p < 0.0001 on one-way analysis of variance). CONCLUSION Prolonged arteriovenous transit times may represent a distinct feature of thoracolumbar spinal dural arteriovenous fistulaes. This may, amongst other factors, play a role in the observed lesser likelihood of hemorrhagic complications compared to other dural arteriovenous shunts.
Collapse
Affiliation(s)
- Ze'ev Itsekzon-Hayosh
- Division of Neuroradiology, Joint Department of Medical Imaging, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
- Departments of Neurology and Neurovascular Disorders, Sheba Medical Center, Affiliated to Tel Aviv University, Sackler Faculty of Medicine, Ramat Gan, Israel
| | - Eef J Hendriks
- Division of Neuroradiology, Joint Department of Medical Imaging, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Sean T O'Reilly
- Division of Neuroradiology, Joint Department of Medical Imaging, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Rabab Al Shahrani
- Division of Neuroradiology, Joint Department of Medical Imaging, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Ronit Agid
- Division of Neuroradiology, Joint Department of Medical Imaging, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Patrick Nicholson
- Division of Neuroradiology, Joint Department of Medical Imaging, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Karel Terbrugge
- Division of Neuroradiology, Joint Department of Medical Imaging, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Ivan Radovanovic
- Department of Neurosurgery, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Hugo Andrade
- Department of Neurosurgery, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Joanna D Schaafsma
- Department of Medicine, Division of Neurology, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
- Department of Neurosurgery, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| |
Collapse
|
28
|
Brossard-Barbosa N, Krings T, Margolin E. Severe Orbital Congestion After a Brow Lift Due to an Osteodural Arteriovenous Fistula. Ophthalmic Plast Reconstr Surg 2023; 39:e25-e26. [PMID: 36095847 DOI: 10.1097/iop.0000000000002262] [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] [Indexed: 01/19/2023]
Abstract
The authors describe a 73-year-old woman who developed worsening proptosis, binocular diplopia, and periorbital pain shortly after undergoing an open subperiosteal brow lift procedure. She was found to have a pre-existing osteodural fistula (ODF) within left frontal bone, which was draining through supraorbital vein (SOV) in cavernous sinus. When SOV was inadvertently severed during a brow lift, blood from the fistula was now redirected in the orbit. This is the first report of a decompensated ODF after a brow lift procedure. It underscores the complexity of orbital venous drainage and the importance in preserving the supraorbital and supratrochlear veins during brow lift.
Collapse
Affiliation(s)
| | - Timo Krings
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, U.S.A
| | - Edward Margolin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, U.S.A
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, U.S.A
| |
Collapse
|
29
|
Harmsen IE, Kim CN, Hendriks EJ, Lindgren A, Krings T. Duplication of the internal maxillary artery: Anatomical and clinical considerations. Interv Neuroradiol 2022:15910199221142094. [PMID: 36437640 DOI: 10.1177/15910199221142094] [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: 02/17/2024] Open
Abstract
Duplication of the internal maxillary artery (IMAX) results from a failed regression of either the embryological superficial or deep ring and is reported to be exceedingly rare. We present a patient with this rare anatomical variant who was treated by endovascular technique in the clinical context of an acute oropharyngeal hemorrhage.
Collapse
Affiliation(s)
- Irene E Harmsen
- Division of Interventional Neuroradiology, Department of Diagnostic Radiology, 26625Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Cha-Ney Kim
- Division of Neuroradiology, Department of Diagnostic Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Eef J Hendriks
- Division of Interventional Neuroradiology, Department of Diagnostic Radiology, 26625Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Antti Lindgren
- Division of Interventional Neuroradiology, Department of Diagnostic Radiology, 26625Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
- Department of Clinical Radiology, 60650Kuopio University Hospital, Kuopio, Finland
- School of Medicine, Faculty of Health Sciences Institute of Clinical Medicine, 220881University of Eastern Finland, Kuopio, Finland
| | - Timo Krings
- Division of Interventional Neuroradiology, Department of Diagnostic Radiology, 26625Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
30
|
Adeeb N, Dibas M, Griessenauer CJ, Cuellar HH, Salem MM, Xiang S, Enriquez-Marulanda A, Hong T, Zhang H, Taussky P, Grandhi R, Waqas M, Aldine AS, Tutino VM, Aslan A, Siddiqui AH, Levy EI, Ogilvy CS, Thomas AJ, Ulfert C, Möhlenbruch MA, Renieri L, Bengzon Diestro JD, Lanzino G, Brinjikji W, Spears J, Vranic JE, Regenhardt RW, Rabinov JD, Harker P, Müller-Thies-Broussalis E, Killer-Oberpfalzer M, Islak C, Kocer N, Sonnberger M, Engelhorn T, Kapadia A, Yang VXD, Salehani A, Harrigan MR, Krings T, Matouk CC, Mirshahi S, Chen KS, Aziz-Sultan MA, Ghorbani M, Schirmer CM, Goren O, Dalal SS, Finkenzeller T, Holtmannspötter M, Buhk JH, Foreman PM, Cress MC, Hirschl RA, Reith W, Simgen A, Janssen H, Marotta TR, Stapleton CJ, Patel AB, Dmytriw AA. Learning Curve for Flow Diversion of Posterior Circulation Aneurysms: A Long-Term International Multicenter Cohort Study. AJNR Am J Neuroradiol 2022; 43:1615-1620. [PMID: 36229166 PMCID: PMC9731249 DOI: 10.3174/ajnr.a7679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Flow diversion has gradually become a standard treatment for intracranial aneurysms of the anterior circulation. Recently, the off-label use of the flow diverters to treat posterior circulation aneurysms has also increased despite initial concerns of rupture and the suboptimal results. This study aimed to explore the change in complication rates and treatment outcomes across time for posterior circulation aneurysms treated using flow diversion and to further evaluate the mechanisms and variables that could potentially explain the change and outcomes. MATERIALS AND METHODS A retrospective review using a standardized data set at multiple international academic institutions was performed to identify patients with ruptured and unruptured posterior circulation aneurysms treated with flow diversion during a decade spanning January 2011 to January 2020. This period was then categorized into 4 intervals. RESULTS A total of 378 procedures were performed during the study period. Across time, there was an increasing tendency to treat more vertebral artery and fewer large vertebrobasilar aneurysms (P = .05). Moreover, interventionalists have been increasingly using fewer overlapping flow diverters per aneurysm (P = .07). There was a trend toward a decrease in the rate of thromboembolic complications from 15.8% in 2011-13 to 8.9% in 2018-19 (P = .34). CONCLUSIONS This multicenter experience revealed a trend toward treating fewer basilar aneurysms, smaller aneurysms, and increased usage of a single flow diverter, leading to a decrease in the rate of thromboembolic and hemorrhagic complications.
Collapse
Affiliation(s)
- N Adeeb
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - M Dibas
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - C J Griessenauer
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
- Department of Neurology/Institut of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - H H Cuellar
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - M M Salem
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - S Xiang
- Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - A Enriquez-Marulanda
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - T Hong
- Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - H Zhang
- Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - P Taussky
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery (P.T., R.G.), University of Utah, Salt Lake City, Utah
| | - R Grandhi
- Department of Neurosurgery (P.T., R.G.), University of Utah, Salt Lake City, Utah
| | - M Waqas
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - A S Aldine
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - V M Tutino
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - A Aslan
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - A H Siddiqui
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - E I Levy
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - C S Ogilvy
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - A J Thomas
- Department of Neurological Surgery (A.J.T.), Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey
| | - C Ulfert
- Department of Neuroradiology (C.U., M.A.M.), Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - M A Möhlenbruch
- Department of Neuroradiology (C.U., M.A.M.), Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - L Renieri
- Department of Interventional Neuroradiology (L.R.), University of Florence, Florence, Italy
| | - J D Bengzon Diestro
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., J.S., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - G Lanzino
- Department of Neurological Surgery (G.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - W Brinjikji
- Department of Neurological Surgery (G.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - J Spears
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., J.S., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - J E Vranic
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - R W Regenhardt
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - J D Rabinov
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - P Harker
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - E Müller-Thies-Broussalis
- Department of Neurology/Institut of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - M Killer-Oberpfalzer
- Department of Neurology/Institut of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - C Islak
- Department of Neuroradiology (C.I., N.K.), Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - N Kocer
- Department of Neuroradiology (C.I., N.K.), Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - M Sonnberger
- Department of Neuroradiology (M.S.), Kepler Universitätsklinikum Linz, Linz, Austria
| | - T Engelhorn
- Department of Neuroradiology (T.E.), University Hospital Erlangen, Erlangen, Germany
| | - A Kapadia
- Departments of Medical Imaging and Neurosurgery (A.K.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - V X D Yang
- Neurointerventional Program (V.X.D.Y., A.A.D.), Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, Ontario, Canada
| | - A Salehani
- Department of Neurosurgery (A. Salehani, M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama
| | - M R Harrigan
- Department of Neurosurgery (A. Salehani, M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama
| | - T Krings
- Division of Interventional Neuroradiology (T.K.), Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - C C Matouk
- Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, Connecticut
| | - S Mirshahi
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - K S Chen
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - M A Aziz-Sultan
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - M Ghorbani
- Division of Vascular and Endovascular Neurosurgery (M.G.), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - C M Schirmer
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
| | - O Goren
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
| | - S S Dalal
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
| | - T Finkenzeller
- Institute of Radiology and Neuroradiology (T.F., M.H.), Klinikum Nuernberg Sued, Paracelsus Medical University Nuernberg, Nuernberg, Germany
| | - M Holtmannspötter
- Institute of Radiology and Neuroradiology (T.F., M.H.), Klinikum Nuernberg Sued, Paracelsus Medical University Nuernberg, Nuernberg, Germany
- Department of Neuroradiology (M.H.), Klinikum Weiden, Weiden, Germany
| | - J-H Buhk
- Department of Neuroradiology (J.-H.B.), University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - P M Foreman
- Neuroscience and Rehabilitation Institute (P.M.F., M.C.C., R.A.H.), Orlando Health, Orlando, Florida
| | - M C Cress
- Neuroscience and Rehabilitation Institute (P.M.F., M.C.C., R.A.H.), Orlando Health, Orlando, Florida
| | - R A Hirschl
- Neuroscience and Rehabilitation Institute (P.M.F., M.C.C., R.A.H.), Orlando Health, Orlando, Florida
| | - W Reith
- Clinic for Diagnostic and Interventional Neuroradiology (W.R., A. Simgen), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - A Simgen
- Clinic for Diagnostic and Interventional Neuroradiology (W.R., A. Simgen), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - H Janssen
- Institute for Neuroradiology (H.J.), Klinikum Ingolstadt, Ingolstadt, Germany
| | - T R Marotta
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., J.S., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - C J Stapleton
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - A B Patel
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - A A Dmytriw
- Neurointerventional Program (V.X.D.Y., A.A.D.), Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, Ontario, Canada
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
31
|
Algra AM, Greving JP, de Winkel J, Kurtelius A, Laban K, Verbaan D, van den Berg R, Vandertop W, Lindgren A, Krings T, Woo PYM, Wong GKC, Roozenbeek B, van Es ACGM, Dammers R, Etminan N, Boogaarts H, van Doormaal T, van der Zwan A, van der Schaaf IC, Rinkel GJE, Vergouwen MDI. Development of the SAFETEA Scores for Predicting Risks of Complications of Preventive Endovascular or Microneurosurgical Intracranial Aneurysm Occlusion. Neurology 2022; 99:e1725-e1737. [PMID: 36240099 DOI: 10.1212/wnl.0000000000200978] [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: 08/31/2021] [Accepted: 06/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Preventive unruptured intracranial aneurysm (UIA) occlusion can reduce the risk of subarachnoid hemorrhage, but both endovascular and microneurosurgical treatment carry a risk of serious complications. To improve individualized management decisions, we developed risk scores for complications of endovascular and microneurosurgical treatment based on easily retrievable patient, aneurysm, and treatment characteristics. METHODS For this multicenter cohort study, we combined individual patient data from patients with UIA aged 18 years or older undergoing preventive endovascular treatment (standard, balloon-assisted or stent-assisted coiling, Woven EndoBridge-device, or flow-diverting stent) or microneurosurgical clipping at one of the 10 participating centers from 3 continents between 2000 and 2018. The primary outcome was death from any cause or clinical deterioration from neurologic complications ≤30 days. We selected predictors based on previous knowledge about relevant risk factors and predictor performance and studied the association between predictors and complications with logistic regression. We assessed model performance with calibration plots and concordance (c) statistics. RESULTS Of the 1,282 included patients, 94 (7.3%) had neurologic symptoms that resolved <30 days, 140 (10.9%) had persisting neurologic symptoms, and 6 died (0.5%). At 30 days, 52 patients (4.1%) were dead or dependent. Predictors of procedural complications were size of aneurysm, aneurysm location, familial subarachnoid hemorrhage, earlier atherosclerotic disease, treatment volume, endovascular modality (for endovascular treatment) or extra aneurysm configuration factors (for microneurosurgical treatment, branching artery from aneurysm neck or unfavorable dome-to-neck ratio), and age (acronym: SAFETEA). For endovascular treatment (n = 752), the c-statistic was 0.72 (95% CI 0.67-0.77) and the absolute complication risk ranged from 3.2% (95% CI 1.6%-14.9%; ≤1 point) to 33.1% (95% CI 25.4%-41.5%; ≥6 points). For microneurosurgical treatment (n = 530), the c-statistic was 0.72 (95% CI 0.67-0.77) and the complication risk ranged from 4.9% (95% CI 1.5%-14.9%; ≤1 point) to 49.9% (95% CI 39.4%-60.6%; ≥6 points). DISCUSSION The SAFETEA risk scores for endovascular and microneurosurgical treatment are based on 7 easily retrievable risk factors to predict the absolute risk of procedural complications in patients with UIAs. The scores need external validation before the predicted risks can be properly used to support decision-making in clinical practice. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that SAFETEA scores predict the risk of procedural complications after endovascular and microneurosurgical treatment of unruptured intracranial aneurysms.
Collapse
Affiliation(s)
- Annemijn M Algra
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Jacoba P Greving
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jordi de Winkel
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arttu Kurtelius
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kamil Laban
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dagmar Verbaan
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - René van den Berg
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - William Vandertop
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Antti Lindgren
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Timo Krings
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter Y M Woo
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - George K C Wong
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bob Roozenbeek
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Adriaan C G M van Es
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ruben Dammers
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nima Etminan
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hieronymus Boogaarts
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tristan van Doormaal
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Albert van der Zwan
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Irene C van der Schaaf
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gabriël J E Rinkel
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mervyn D I Vergouwen
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
32
|
Larson AS, Brinjikji W, Krings T, Guerin JB. The cerebrofacial metameric syndromes: An embryological review and proposal of a novel classification scheme. Interv Neuroradiol 2022; 28:595-603. [PMID: 34665049 PMCID: PMC9511621 DOI: 10.1177/15910199211044938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/09/2021] [Accepted: 08/20/2021] [Indexed: 11/15/2022] Open
Abstract
The cerebrofacial metameric syndromes are a group of congenital syndromes that result in vascular malformations throughout specific anatomical distributions of the brain, cranium and face. Multiple reports of patients with high-flow or low-flow vascular malformations following a metameric distribution have supported this idea. There has been much advancement in understanding of segmental organization and cell migration since the concept of metameric vascular syndromes was first proposed. We aim to give an updated review of these embryological considerations and then propose a more detailed classification system for these syndromes, predominately incorporating the contribution of neural crest cells and somitomeres to the pharyngeal arches.
Collapse
Affiliation(s)
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, USA
- Department of Neurosurgery, Mayo Clinic, USA
| | - Timo Krings
- Division of Neuroradiology, University of Toronto and Toronto Western Hospital, Canada
| | | |
Collapse
|
33
|
Savage C, Hale AT, Parr MS, Hedaya A, Saccomano BW, Tsemo GB, Hafeez MU, Tanweer O, Kan P, Solomon LJ, Meila D, Dirks PB, Blount JP, Johnston JM, Rocque BG, Rozzelle CJ, Bhatia K, Muthusami P, Krings T, Jones J. Outcomes of endovascular embolization for Vein of Galen malformations: An individual participant data meta-analysis. Front Pediatr 2022; 10:976060. [PMID: 36245731 PMCID: PMC9561813 DOI: 10.3389/fped.2022.976060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Understanding outcomes after Vein of Galen malformation (VOGM) embolization has been limited by small sample size in reported series and predominantly single center studies. To address these limitations, we perform an individual-participant meta-analysis (IPMA) to identify risk factors associated with all-cause mortality and clinical outcome after VOGM endovascular embolization. Methods We performed a systematic review and IPMA of VOGM endovascular outcomes according to PRISMA guidelines. Individual patient characteristics including demographic, intra/post-operative adverse events, treatment efficacy (partial or complete occlusion), and clinical outcome were collected. Mixed-effects logistic regression with random effects modeling and Bonferroni correction was used (p ≤ 0.003 threshold for statistical significance). The primary and secondary outcomes were all-cause mortality and poor clinical outcome (moderate/severe developmental delay or permanent disabling injury), respectively. Data are expressed as (mean ± standard deviation (SD)) or (odds ratio (OR), 95% confidence interval (CI), I 2, p-value). Results Thirty-five studies totaling 307 participants quantifying outcomes after endovascular embolization for VOGM were included. Follow up time was 42 (±57) months. Our analysis contained 42% neonates (<1 month) at first embolization, 45% infants (1 month ≤2 years), and 13% children (>2 years). Complete occlusion was reported in 48% of participants. Overall all-cause mortality was 16%. Overall, good clinical outcome was achieved in 68% of participants. First embolization as a neonate [OR = 6.93; 95% CI (1.99-24.08); I 2 < 0.01; p < 0.001] and incomplete embolization [OR = 10.87; 95% CI (1.86-63.55); I 2 < 0.01; p < 0.001] were associated with mortality. First embolization as a neonate [OR = 3.24; 95% CI (1.47-7.15); I 2 < 0.01; p < 0.001], incomplete embolization [OR = 5.26; 95% CI (2.06-13.43); I 2 < 0.01; p < 0.001], and heart failure at presentation [OR = 3.10; 95% CI (1.03-9.33); I 2 < 0.01; p = 0.002] were associated with poor clinical outcomes. Sex, angioarchitecture of lesion, embolization approach (transvenous vs. transarterial), and single or multistage embolization were not associated with mortality or clinical outcome. Conclusions We identify incomplete VOGM embolization independently associated with mortality and poor clinical outcome. While this study provides the highest level of evidence for VOGM embolization to date, prospective multicenter studies are needed to understand the optimal treatment strategies, outcomes, and natural history after VOGM embolization.
Collapse
Affiliation(s)
- Cody Savage
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andrew T. Hale
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Matthew S. Parr
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Alexander Hedaya
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Benjamin W. Saccomano
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Georges Bouobda Tsemo
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Muhammad U. Hafeez
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Omar Tanweer
- Department of Neurosurgery, Baylor College of Medicine, Houston TX, United States
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Laurent J. Solomon
- Department of Obstetrics and Fetal Medicine, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants, Paris, France
| | - Dan Meila
- Department of Interventional Radiology, Helois Klinikum Krefeld, Johanna-Etienne Hospital Neuss, Neuss, Germany
| | - Peter B. Dirks
- Division of Pediatric Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jeffrey P. Blount
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James M. Johnston
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Brandon G. Rocque
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Curtis J. Rozzelle
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kartik Bhatia
- Department of Medical Imaging, Sydney Children’s Hospital Network, Westmead, NSW, Australia
| | - Prakash Muthusami
- Division of Interventional Radiology, University of Toronto and the Hospital for Sick Children, Toronto, ON, Canada
| | - Timo Krings
- Division of Interventional Radiology, University of Toronto and the Hospital for Sick Children, Toronto, ON, Canada
| | - Jesse Jones
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| |
Collapse
|
34
|
Gao P, Wang T, Wang D, Liebeskind DS, Shi H, Li T, Zhao Z, Cai Y, Wu W, He W, Yu J, Zheng B, Wang H, Wu Y, Dmytriw AA, Krings T, Derdeyn CP, Jiao L. Effect of Stenting Plus Medical Therapy vs Medical Therapy Alone on Risk of Stroke and Death in Patients With Symptomatic Intracranial Stenosis: The CASSISS Randomized Clinical Trial. JAMA 2022; 328:534-542. [PMID: 35943472 PMCID: PMC9364128 DOI: 10.1001/jama.2022.12000] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/27/2022] [Indexed: 12/31/2022]
Abstract
Importance Prior randomized trials have generally shown harm or no benefit of stenting added to medical therapy for patients with symptomatic severe intracranial atherosclerotic stenosis, but it remains uncertain as to whether refined patient selection and more experienced surgeons might result in improved outcomes. Objective To compare stenting plus medical therapy vs medical therapy alone in patients with symptomatic severe intracranial atherosclerotic stenosis. Design, Setting, and Participants Multicenter, open-label, randomized, outcome assessor-blinded trial conducted at 8 centers in China. A total of 380 patients with transient ischemic attack or nondisabling, nonperforator (defined as nonbrainstem or non-basal ganglia end artery) territory ischemic stroke attributed to severe intracranial stenosis (70%-99%) and beyond a duration of 3 weeks from the latest ischemic symptom onset were recruited between March 5, 2014, and November 10, 2016, and followed up for 3 years (final follow-up: November 10, 2019). Interventions Medical therapy plus stenting (n = 176) or medical therapy alone (n = 182). Medical therapy included dual-antiplatelet therapy for 90 days (single antiplatelet therapy thereafter) and stroke risk factor control. Main Outcomes and Measures The primary outcome was a composite of stroke or death within 30 days or stroke in the qualifying artery territory beyond 30 days through 1 year. There were 5 secondary outcomes, including stroke in the qualifying artery territory at 2 years and 3 years as well as mortality at 3 years. Results Among 380 patients who were randomized, 358 were confirmed eligible (mean age, 56.3 years; 263 male [73.5%]) and 343 (95.8%) completed the trial. For the stenting plus medical therapy group vs medical therapy alone, no significant difference was found for the primary outcome of risk of stroke or death (8.0% [14/176] vs 7.2% [13/181]; difference, 0.4% [95% CI, -5.0% to 5.9%]; hazard ratio, 1.10 [95% CI, 0.52-2.35]; P = .82). Of the 5 prespecified secondary end points, none showed a significant difference including stroke in the qualifying artery territory at 2 years (9.9% [17/171] vs 9.0% [16/178]; difference, 0.7% [95% CI, -5.4% to 6.7%]; hazard ratio, 1.10 [95% CI, 0.56-2.16]; P = .80) and 3 years (11.3% [19/168] vs 11.2% [19/170]; difference, -0.2% [95% CI, -7.0% to 6.5%]; hazard ratio, 1.00 [95% CI, 0.53-1.90]; P > .99). Mortality at 3 years was 4.4% (7/160) in the stenting plus medical therapy group vs 1.3% (2/159) in the medical therapy alone group (difference, 3.2% [95% CI, -0.5% to 6.9%]; hazard ratio, 3.75 [95% CI, 0.77-18.13]; P = .08). Conclusions and Relevance Among patients with transient ischemic attack or ischemic stroke due to symptomatic severe intracranial atherosclerotic stenosis, the addition of percutaneous transluminal angioplasty and stenting to medical therapy, compared with medical therapy alone, resulted in no significant difference in the risk of stroke or death within 30 days or stroke in the qualifying artery territory beyond 30 days through 1 year. The findings do not support the addition of percutaneous transluminal angioplasty and stenting to medical therapy for the treatment of patients with symptomatic severe intracranial atherosclerotic stenosis. Trial Registration ClinicalTrials.gov Identifier: NCT01763320.
Collapse
Affiliation(s)
- Peng Gao
- Departments of Neurosurgery and Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Wang
- Departments of Neurosurgery and Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - David S. Liebeskind
- David Geffen School of Medicine, Department of Neurology and Comprehensive Stroke Center, University of California, Los Angeles
| | - Huaizhang Shi
- Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tianxiao Li
- Department of Cerebrovascular and Neurosurgery, Henan Provincial People’s Hospital, Zhengzhou University, Zhengzhou, China
| | - Zhenwei Zhao
- Department of Neurosurgery, Tangdu Hospital of Air Force Medical University, Xi’an, China
| | - Yiling Cai
- Department of Neurology, Strategic Support Force Medical Center, Beijing, China
| | - Wei Wu
- Department of Neurology, Qilu Hospital of Shandong University, Ji’nan, China
| | - Weiwen He
- Department of Neurosurgery, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jia Yu
- Department of Neurosurgery, Tangdu Hospital of Air Force Medical University, Xi’an, China
| | - Bingjie Zheng
- Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Haibo Wang
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Adam A. Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Timo Krings
- Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Colin P. Derdeyn
- Departments of Radiology and Neurology, University of Iowa Hospitals and Clinics, Iowa City
| | - Liqun Jiao
- Departments of Neurosurgery and Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
35
|
Hainc N, McAndrews MP, Valiante T, Andrade DM, Wennberg R, Krings T. Imaging in medically refractory epilepsy at 3 Tesla: a 13-year tertiary adult epilepsy center experience. Insights Imaging 2022; 13:99. [PMID: 35661273 PMCID: PMC9167324 DOI: 10.1186/s13244-022-01236-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives MRI negative epilepsy has evolved through increased usage of 3 T and insights from surgically correlated studies. The goal of this study is to describe dedicated 3 T epilepsy MRI findings in medically refractory epilepsy (MRE) patients at a tertiary epilepsy center to familiarize radiologists with an updated spectrum and frequency of potential imaging findings in the adult MRE population. Methods Included were all patients with MRE admitted to the epilepsy monitoring unit who were discussed at weekly interdisciplinary imaging conferences at Toronto Western Hospital with MRI studies (3 T with dedicated epilepsy protocol) performed between January 2008 and January 2021. Lesion characterization was performed by two readers based on most likely imaging diagnosis in consensus. Lobes involved per case were recorded. Results A total of 738 patients (386 female; mean age 35 years, range 15–77) were included. A total of 262 patients (35.5%) were MRI negative. The most common imaging finding was mesial temporal sclerosis, seen in 132 patients (17.9%), followed by encephalomalacia and gliosis, either posttraumatic, postoperative, postischemic, or postinfectious in nature, in 79 patients (10.7%). The most common lobar involvement (either partially or uniquely) was temporal (341 cases, 58.6%). MRE patients not candidates for surgical resection were included in the study, as were newly described pathologies from surgically correlated studies revealing findings seen retrospectively on reported MRI negative exams (isolated enlargement of the amygdala, temporal pole white matter abnormality, temporal encephalocele). Conclusion This study provides an updated description of the spectrum of 3 T MRI findings in adult MRE patients from a tertiary epilepsy center.
Collapse
Affiliation(s)
- Nicolin Hainc
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. .,Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Mary Pat McAndrews
- Krembil Brain Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Taufik Valiante
- Krembil Brain Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Danielle M Andrade
- Krembil Brain Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Richard Wennberg
- Krembil Brain Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
36
|
O'Reilly ST, Hendriks EJ, Brunet MC, Itsekson Z, Shahrani RA, Agid R, Nicholson P, terBrugge K, Radovanovic I, Krings T. Recognition of the variant type of spinal dural arteriovenous fistula: a rare but important consideration. J Neurosurg Spine 2022; 37:1-5. [PMID: 35523253 DOI: 10.3171/2022.3.spine22225] [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: 02/18/2022] [Accepted: 03/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spinal dural arteriovenous fistulas (SDAVFs) typically represent abnormal shunts between a radiculomeningeal artery and radicular vein, with the point of fistulization classically directly underneath the pedicle of the vertebral body, at the dural sleeve of the nerve root. However, SDAVFs can also develop in atypical locations or have more than one arterial feeder, which is a variant of SDAVF. The aim of this study was to describe the incidence and multidisciplinary treatment of variant SDAVFs in a single-center case series. METHODS Following institutional review board approval, the authors retrospectively analyzed their prospectively maintained database of patients with SDAVFs who presented between 2008 and 2020. For all patients, spinal digital subtraction angiograms were reviewed and variant SDAVFs were identified. Variant types of SDAVFs were defined as cases in which the fistulous point was not located underneath the pedicle. Patient demographics, angiographic features, clinical outcomes, and treatment modalities were assessed. RESULTS Of 59 patients with SDAVFs treated at the authors' institution, 4 patients (6.8%) were identified as having a variant location of the shunt zone, pinpointed on the dura mater at the intervertebral level, further posteriorly within the spinal canal. In 3 cases (75%), a so-called bimetameric arterial supply was demonstrated. CONCLUSIONS Recognition of the variant type of SDAVF is crucial for management, as correct localization of the fistulous point and bimetameric supply are critical for successful surgical disconnection, preventing delay in achieving definitive treatment.
Collapse
Affiliation(s)
- Sean T O'Reilly
- 1Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- 2Department of Neuroradiology, Royal Victoria Hospital, Belfast, County Antrim, United Kingdom; and
| | - Eef Jacobus Hendriks
- 1Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Marie-Christine Brunet
- 1Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ze'ev Itsekson
- 1Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Rabab Al Shahrani
- 1Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ronit Agid
- 1Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Patrick Nicholson
- 1Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Karel terBrugge
- 1Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ivan Radovanovic
- 3Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Timo Krings
- 1Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- 3Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
37
|
Ganesh A, Goyal M, Wilson AT, Ospel JM, Demchuk AM, Mikulis D, Poublanc J, Krings T, Anderson R, Tymianski M, Hill MD. Association of Iatrogenic Infarcts With Clinical and Cognitive Outcomes in the Evaluating Neuroprotection in Aneurysm Coiling Therapy Trial. Neurology 2022; 98:e1446-e1458. [PMID: 35169007 DOI: 10.1212/wnl.0000000000200111] [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: 06/09/2021] [Accepted: 01/11/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Small iatrogenic brain infarcts are often seen on diffusion-weighted MRI (DWI) following surgical or endovascular procedures, but there are few data on their clinical effects. We examined the association of iatrogenic infarcts with outcomes in the ENACT (Evaluating Neuroprotection in Aneurysm Coiling Therapy) randomized controlled trial of nerinetide in patients undergoing endovascular repair of intracranial aneurysms. METHODS In this post hoc analysis, we used multivariable models to evaluate the association of the presence and number of iatrogenic infarcts on DWI with neurologic impairment (NIH Stroke Scale [NIHSS]), functional status (modified Rankin Scale [mRS]), and cognitive and neuropsychiatric outcomes (30-minute test battery) at 1-4 days and 30 days postprocedure. We also related infarct number to a z score-derived composite outcome score using quantile regression. RESULTS Among 184 patients (median age 56 years [interquartile range (IQR) 50-64]), 124 (67.4%) had postprocedural DWI lesions (median 4, IQR 2-10.5). Nerinetide treatment was associated with fewer iatrogenic infarcts but no overall significant clinical treatment effects. Patients with infarcts had lower Mini-Mental State Examination (MMSE) scores at 2-4 days (median 28 vs 29, adjusted coefficient [acoef] -1.11, 95% CI -1.88 to -0.34, p = 0.005). Higher lesion counts were associated with worse day 1 NIHSS (adjusted odds ratio for NIHSS ≥1: 1.07, 1.02-1.12, p = 0.009), day 2-4 mRS (adjusted common odds ratio [acOR] 1.05, 1.01-1.09, p = 0.005), and day 2-4 MMSE (acoef -0.07, -0.13 to -0.003, p = 0.040) scores. At 30 days, infarct number remained associated with worse mRS (acOR 1.04, 1.01-1.07, p = 0.016) and Hopkins Verbal Learning Test (HVLT) delayed recall scores (acoef -0.21, -0.39 to -0.03, p = 0.020). Patients with infarcts trended towards lower 30-day Digit Symbol Substitution Test (DSST) scores (acoef -3.73, -7.36 to -0.10, p = 0.044). Higher lesion count was associated with worse composite outcome scores at both 1-4 days and 30 days (30-day acoef -0.12, 95% CI -0.21 to -0.03, p = 0.008). Among those with infarcts, day 1 NIHSS and day 2-4 mRS correlated with 30-day NIHSS, DSST, HVLT, and mRS scores, whereas day 2-4 MMSE correlated with 30-day NIHSS and DSST scores (Spearman ρ 0.47, p = 0.001). DISCUSSION Iatrogenic brain infarcts were associated with subtle differences in postprocedural (1-4 days) and 30-day outcomes on different measures in this middle-aged cohort, with earlier dysfunction correlating with later differences. TRIAL REGISTRATION INFORMATION Clinical trials registration NCT00728182.
Collapse
Affiliation(s)
- Aravind Ganesh
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - Mayank Goyal
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - Alexis T Wilson
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - Johanna Maria Ospel
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - Andrew M Demchuk
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - David Mikulis
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - Julien Poublanc
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - Timo Krings
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - Roberta Anderson
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - Michael Tymianski
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - Michael D Hill
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | | |
Collapse
|
38
|
Bhatia KD, Lee H, Kortman H, Klostranec J, Guest W, Wälchli T, Radovanovic I, Krings T, Pereira VM. Endovascular Management of Intracranial Dural AVFs: Transvenous Approach. AJNR Am J Neuroradiol 2022; 43:510-516. [PMID: 34649915 DOI: 10.3174/ajnr.a7300] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/09/2021] [Indexed: 11/07/2022]
Abstract
In this third review article on the endovascular management of intracranial dural AVFs, we discuss transvenous embolization approaches. Transvenous embolization is increasingly popular and now the first-line approach for ventral dural AVFs involving the cavernous sinus and hypoglossal canal. In addition, transvenous embolization is increasingly used in lateral epidural dural AVFs in high-risk locations such as the petrous and ethmoid regions. The advantage of transvenous embolization in these locations is the ability to retrogradely embolize the draining vein and fistula while reducing the risk of ischemic cranial neuropathy or brain parenchymal infarction commonly feared from a transarterial approach. By means of coils ± ethylene-vinyl alcohol copolymer, transvenous embolization can achieve angiographic cure rates of 80%-90% in ventral locations. Potential complications include transient cranial neuropathy, neurologic deterioration due to venous outflow obstruction, and perforation while navigating pial veins. Transvenous embolization should be considered when dural AVFs arise in proximity to the vasa nervosum or extracranial-intracranial anastomoses.
Collapse
Affiliation(s)
- K D Bhatia
- From the Division of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.)
- Division of Medical Imaging (K.D.B.), Sydney Children's Hospital Network, Westmead, New South Wales, Australia
- Division of Paediatrics (K.D.B.), Faculty of Medicine, University of Sydney, Camperdown, New South Wales, Australia
- Division of Paediatrics (K.D.B.), Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- Division of Medical Imaging (K.D.B.), Faculty of Medicine, Macquarie University, Macquarie Park, New South Wales, Australia
| | - H Lee
- From the Division of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.)
- Department of Neurosurgery (H.L.), Stanford University School of Medicine, Stanford, California
| | - H Kortman
- From the Division of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.)
- Division of Neuroradiology (H.K.), Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands
| | - J Klostranec
- From the Division of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.)
- Division of Interventional Neuroradiology (J.K.), McGill University Health Centre, Montreal, Quebec, Canada
| | - W Guest
- From the Division of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.)
- Division of Interventional Neuroradiology (W.G., V.M.P.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - T Wälchli
- Division of Neurosurgery (T.W., I.R., T.K., V.M.P.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - I Radovanovic
- Division of Neurosurgery (T.W., I.R., T.K., V.M.P.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - T Krings
- From the Division of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.)
- Division of Neurosurgery (T.W., I.R., T.K., V.M.P.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - V M Pereira
- From the Division of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.)
- Division of Neurosurgery (T.W., I.R., T.K., V.M.P.), Toronto Western Hospital, Toronto, Ontario, Canada
- Division of Interventional Neuroradiology (W.G., V.M.P.), St. Michael's Hospital, Toronto, Ontario, Canada
| |
Collapse
|
39
|
Bhatia K, Lee H, Kortman H, Klostranec J, Guest W, Wälchli T, Radovanovic I, Krings T, Pereira V. Endovascular Management of Intracranial Dural Arteriovenous Fistulas: Transarterial Approach. AJNR Am J Neuroradiol 2022; 43:324-331. [PMID: 34620593 PMCID: PMC8910823 DOI: 10.3174/ajnr.a7296] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/03/2021] [Indexed: 01/02/2023]
Abstract
In this second of 3 review articles on the endovascular management of intracranial dural AVFs, we discuss transarterial treatment approaches. The treatment goal is to occlude the fistulous point, including the most distal portion of the arterial supply together with the most proximal portion of the draining vein (ie, the "foot" of the vein), which can be accomplished with liquid embolic agents via transarterial access. Anatomic factors to consider when assessing the safety and efficacy of a transarterial approach using liquid embolic agents include location, angioarchitecture, and proximity of arterial feeders to both the vasa nervosum of adjacent cranial nerves and the external carotid-internal carotid/vertebral artery anastomoses. Anatomic locations typically favorable for transarterial approaches include but are not limited to the transverse/sigmoid sinus, cerebral convexity, and superior sagittal sinus. In this review article, we discuss the technical approaches, outcomes, potential complications, and complication avoidance strategies for transarterial embolization.
Collapse
Affiliation(s)
- K.D. Bhatia
- From the Divisions of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K.),Department of Medical Imaging (K.D.B.), Sydney Children’s Hospital Network, Westmead, New South Wales, Australia,Division of Paediatrics (K.D.B.), Faculty of Medicine, University of Sydney, Camperdown, New South Wales, Australia,Division of Paediatrics (K.D.B.), Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia,Division of Medical Imaging (K.D.B.), Faculty of Medicine, Macquarie University, Macquarie Park, New South Wales, Australia
| | - H. Lee
- From the Divisions of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K.)
| | - H. Kortman
- From the Divisions of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K.)
| | - J. Klostranec
- From the Divisions of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K.)
| | - W. Guest
- From the Divisions of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K.)
| | - T. Wälchli
- Neurosurgery (T.W., I.R., T.K.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - I. Radovanovic
- Neurosurgery (T.W., I.R., T.K.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - T. Krings
- From the Divisions of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K.),Neurosurgery (T.W., I.R., T.K.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - V.M. Pereira
- Division of Interventional Neuroradiology (V.M.P.), St Michael’s Hospital, Toronto, Ontario, Canada
| |
Collapse
|
40
|
Klostranec JM, Krings T. Cerebral neurovascular embryology, anatomic variations, and congenital brain arteriovenous lesions. J Neurointerv Surg 2022; 14:910-919. [PMID: 35169032 DOI: 10.1136/neurintsurg-2021-018607] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 12/14/2022]
Abstract
Cerebral neurovascular development is a complex and coordinated process driven by the changing spatial and temporal metabolic demands of the developing brain. Familiarity with the process is helpful in understanding neurovascular anatomic variants and congenital arteriovenous shunting lesions encountered in endovascular neuroradiological practice. Herein, the processes of vasculogenesis and angiogenesis are reviewed, followed by examination of the morphogenesis of the cerebral arterial and venous systems. Common arterial anatomic variants are reviewed with an emphasis on their development. Finally, endothelial genetic mutations affecting angiogenesis are examined to consider their probable role in the development of three types of congenital brain arteriovenous fistulas: vein of Galen malformations, pial arteriovenous fistulas, and dural sinus malformations.
Collapse
Affiliation(s)
- Jesse M Klostranec
- Department of Neuroradiology, Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada .,McGill University Health Centre, Montreal, Quebec, Canada
| | - Timo Krings
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
41
|
Bhatia KD, Lee H, Kortman H, Klostranec J, Guest W, Wälchli T, Radovanovic I, Krings T, Pereira VM. Endovascular Management of Intracranial Dural AVFs: Principles. AJNR Am J Neuroradiol 2022; 43:160-166. [PMID: 34674996 PMCID: PMC8985683 DOI: 10.3174/ajnr.a7304] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/07/2021] [Indexed: 02/03/2023]
Abstract
Intracranial dural AVFs are abnormal communications between arteries that supply the dura mater and draining cortical veins or venous sinuses. They are believed to form as a response to venous insults such as thrombosis, trauma, or infection. Classification and management are dependent on the presence of drainage/reflux into cortical veins because such drainage markedly elevates the risk of hemorrhage or venous congestion, resulting in neurologic deficits. AVFs with tolerable symptoms and benign drainage patterns can be managed conservatively. Intolerable symptoms, presentation with hemorrhage/neurologic deficits, or aggressive drainage patterns are indications for intervention. Treatment options include microsurgical disconnection, endovascular transarterial embolization, transvenous embolization, or a combination. This is the first in a series of 3 articles on endovascular management of intracranial dural AVFs, in which we outline the principles and outcomes of endovascular treatment.
Collapse
Affiliation(s)
- K D Bhatia
- From the Divisions of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.) .,Department of Medical Imaging (K.D.B.), Sydney Children's Hospital Network, Westmead, New South Wales, Australia.,Division of Paediatrics (K.D.B.), Faculty of Medicine, University of Sydney, Camperdown, New South Wales, Australia.,Division of Paediatrics (K.D.B.), Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia.,Division of Medical Imaging (K.D.B.), Faculty of Medicine, Macquarie University, Macquarie Park, New South Wales, Australia
| | - H Lee
- From the Divisions of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.)
| | - H Kortman
- From the Divisions of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.)
| | - J Klostranec
- From the Divisions of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.)
| | - W Guest
- From the Divisions of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.)
| | - T Wälchli
- Neurosurgery (T.W., I.R., T.K., V.M.P.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - I Radovanovic
- Neurosurgery (T.W., I.R., T.K., V.M.P.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - T Krings
- From the Divisions of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.).,Neurosurgery (T.W., I.R., T.K., V.M.P.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - V M Pereira
- From the Divisions of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.).,Neurosurgery (T.W., I.R., T.K., V.M.P.), Toronto Western Hospital, Toronto, Ontario, Canada
| |
Collapse
|
42
|
Adams HP, Adeoye O, Albers GW, Alexandrov AV, Amin-Hanjani S, An H, Anderson CS, Anrather J, Aparicio HJ, Arai K, Aronowski J, Atchaneeyasakul K, Audebert H, Auer RN, Awad IA, Ay H, Baltan S, Balu R, Behbahani M, Benavente OR, Bershad EM, Berthaud JV, Blackburn SL, Bonati LH, Bösel J, Bousser MG, Broderick JP, Brown MM, Brown W, Brust JC, Bushnell C, Canhão P, Caplan LR, Carrión-Penagos J, Castellanos M, Caunca MR, Chabriat H, Chamorro A, Chen J, Chen J, Chopp M, Christorforids G, Connolly ES, Cramer SC, Cucchiara BL, Czap AL, Dannenbaum MJ, Davis PH, Dawson TM, Dawson VL, Day AL, De Silva TM, de Sousa DA, Del Brutto VJ, del Zoppo GJ, Derdeyn CP, Di Tullio MR, Diener HC, Diringer MN, Dobkin BH, Dzialowski I, Elkind MS, Elm J, Feigin VL, Ferro JM, Field TS, Fischer M, Fornage M, Furie KL, Garcia-Bonilla L, Giannotta SL, Gobin YP, Goldberg MP, Goldstein LB, Gonzales NR, Greer DM, Grotta JC, Guo R, Gutierrez J, Harmel P, Howard G, Howard VJ, Hwang JY, Iadecola C, Jahan R, Jickling GC, Joutel A, Kasner SE, Katan M, Kellner CP, Khan M, Kidwell CS, Kim H, Kim JS, Kircher CE, Krings T, Krishnamurthi RV, Kurth T, Lansberg MG, Levy EI, Liebeskind DS, Liew SL, Lin DJ, Lisle B, Lo EH, Lyden PD, Maki T, Maragkos GA, Marosfoi M, McCullough LD, Meckler JM, Meschia JF, Messé SR, Mocco J, Mokin M, Mooney MA, Morgenstern LB, Moskowitz MA, Mullen MT, Nägel S, Nedergaard M, Neira JA, Newman S, Nicholson PJ, Norrving B, O’Donnell M, Ofengeim D, Ogata J, Ogilvy CS, Orrù E, Ortega-Gutiérrez S, Padrick MM, Parsha K, Parsons M, Patel NV, Patel VI, Pawlikowska L, Pérez A, Perez-Pinzon MA, Picard JM, Polster SP, Powers WJ, Puetz V, Putaala J, Rabinovich M, Ransom BR, Roa JA, Rosenberg GA, Rossitto CP, Rundek T, Russin JJ, Sacco RL, Safouris A, Samaniego EA, Sansing LH, Satani N, Sattenberg RJ, Saver JL, Savitz SI, Schmidt C, Seshadri S, Sharma VK, Sharp FR, Sheth KN, Siddiqi OK, Singhal AB, Sobey CG, Sommer CJ, Spetzler RF, Stapleton CJ, Strickland BA, Su H, Suarez JI, Takayama H, Tarsia J, Tatlisumak T, Thomas AJ, Thompson JW, Tsivgoulis G, Tournier-Lasserve E, Vidal G, Wakhloo AK, Weksler BB, Willey JZ, Wintermark M, Wong LK, Xi G, Xu J, Yaghi S, Yamaguchi T, Yang T, Yasaka M, Zahuranec DB, Zhang F, Zhang JH, Zheng Z, Zukin RS, Zweifler RM. Contributors. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.01002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
43
|
Nicholson P, Krings T. Interventional Therapy of Brain and Spinal Arteriovenous Malformations. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00069-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
44
|
Cancelliere NM, Lynch J, Nicholson P, Dobrocky T, Swaminathan SK, Hendriks EJ, Krings T, Radovanovic I, Drake KE, Turner R, Sungur JM, Pereira VM. Robotic-assisted intracranial aneurysm treatment: 1 year follow-up imaging and clinical outcomes. J Neurointerv Surg 2021; 14:1229-1233. [PMID: 34911735 DOI: 10.1136/neurintsurg-2021-017865] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/06/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The use of robotics in medicine may enable increased technical accuracy, reduced procedural time and radiation exposure, and remote completion of procedures. We have previously described the first-in-human, robotic-assisted cerebral aneurysm treatment using the CorPath GRX Robotic System. In this report we discuss our early experiences and outcomes using this robotic device for endovascular treatment of intracranial aneurysms using stent-assisted coil embolization and flow diversion. METHODS The patient and disease characteristics, procedural details, and follow-up imaging and clinical outcomes of consecutive patients undergoing robotically-assisted intracranial aneurysm embolization between November 2019 and February 2020 are presented. RESULTS Six patients underwent robotically-assisted embolization of intracranial aneurysms. Four of the patients were treated with a neck-bridging stent (with or without coiling) and two patients were treated with a flow-diverting stent. Two patients were treated in the subacute period of subarachnoid hemorrhage and four patients were treated electively. All of the procedures could be completed robotically and there was no need for unplanned manual intervention. The technical success rate of the procedures was 100%. There was no morbidity or mortality associated with the procedures. One year follow-up imaging showed that four aneurysms were completely obliterated (Raymond-Roy Occlusion Classification (RROC) class I) and the remaining two were occluded with a residual neck (RROC class II). CONCLUSIONS The Corpath GRX Robotic System demonstrated a precise control over the microcatheter, wire and stent during aneurysm treatment. Robotic neuro-procedures seem to be safe and effective and demonstrate stable occlusion results in the midterm follow-up.
Collapse
Affiliation(s)
- Nicole Mariantonia Cancelliere
- Division of Neurosurgery, Department of Surgery, RADIS Lab, Li Ka-shing Knowledge Institute, St. Michael's hospital, Toronto, Ontario, Canada
| | - Jeremy Lynch
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Tomas Dobrocky
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Saravana Kumar Swaminathan
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Eef Jacobus Hendriks
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Ivan Radovanovic
- Division of Neurosurgery, Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Kaitlyn E Drake
- Department of Research and Development, Corindus Vascular Robotics, Waltham, Massachusetts, USA
| | - Raymond Turner
- Department of Research and Development, Corindus Vascular Robotics, Waltham, Massachusetts, USA.,Department of Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - John-Michael Sungur
- Department of Research and Development, Corindus Vascular Robotics, Waltham, Massachusetts, USA
| | - Vitor M Pereira
- Division of Neurosurgery, Departments of Surgery & Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
45
|
Griessenauer CJ, Enriquez-Marulanda A, Taussky P, Biswas A, Grandhi R, Xiang S, Hong T, Rinaldo L, Lanzino G, Brinjikji W, Burkhardt JK, Kan P, Ghuman M, Yang VXD, Chen K, Aziz-Sultan MA, Ghorbani M, Schirmer CM, Goren O, Dalal SS, Killer-Oberpfalzer M, Müller-Thies-Broussalis E, Koch MJ, Stapleton CJ, Patel AB, Foreman PM, Cress MC, Hirschl RA, Krings T, Zhang H, Dmytriw AA. Experience With the Pipeline Embolization Device for Posterior Circulations Aneurysms: A Multicenter Cohort Study. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa277_s052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
46
|
Kortman H, Bhatia KD, Nicholson P, Wälchli T, Krings T. In Reply to the Letter to the Editor Regarding 'Symptomatic Unruptured Arteriovenous Malformations: Focal Oedema, Thrombosis and Vessel Wall Enhancement. A Retrospective Cohort Study'. World Neurosurg 2021; 155:210-211. [PMID: 34724744 DOI: 10.1016/j.wneu.2021.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Hans Kortman
- Division of Neuroradiology, Department of Radiology, ETZ Elisabeth Hospital, Tilburg, the Netherlands.
| | - Kartik Dev Bhatia
- Division of Neuroradiology, JDMI, University Health Network, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Division of Neuroradiology, JDMI, University Health Network, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Wälchli
- Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, JDMI, University Health Network, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
47
|
Klostranec JM, Vucevic D, Bhatia KD, Kortman HGJ, Krings T, Murphy KP, terBrugge KG, Mikulis DJ. Current Concepts in Intracranial Interstitial Fluid Transport and the Glymphatic System: Part II-Imaging Techniques and Clinical Applications. Radiology 2021; 301:516-532. [PMID: 34698564 DOI: 10.1148/radiol.2021204088] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The glymphatic system is a recently discovered network unique to the central nervous system that allows for dynamic exchange of interstitial fluid (ISF) and cerebrospinal fluid (CSF). As detailed in part I, ISF and CSF transport along paravascular channels of the penetrating arteries and possibly veins allow essential clearance of neurotoxic solutes from the interstitium to the CSF efflux pathways. Imaging tests to investigate this neurophysiologic function, although challenging, are being developed and are reviewed herein. These include direct visualization of CSF transport using postcontrast imaging techniques following intravenous or intrathecal administration of contrast material and indirect glymphatic assessment with detection of enlarged perivascular spaces. Application of MRI techniques, including intravoxel incoherent motion, diffusion tensor imaging, and chemical exchange saturation transfer, is also discussed, as are methods for imaging dural lymphatic channels involved with CSF efflux. Subsequently, glymphatic function is considered in the context of proteinopathies associated with neurodegenerative diseases and traumatic brain injury, cytotoxic edema following acute ischemic stroke, and chronic hydrocephalus after subarachnoid hemorrhage. These examples highlight the substantial role of the glymphatic system in neurophysiology and the development of certain neuropathologic abnormalities, stressing the importance of its consideration when interpreting neuroimaging investigations. © RSNA, 2021.
Collapse
Affiliation(s)
- Jesse M Klostranec
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Diana Vucevic
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Kartik D Bhatia
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Hans G J Kortman
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Timo Krings
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Kieran P Murphy
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Karel G terBrugge
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - David J Mikulis
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| |
Collapse
|
48
|
Hainc N, Alsafwani N, Gao A, O'Halloran PJ, Kongkham P, Zadeh G, Gutierrez E, Shultz D, Krings T, Alcaide-Leon P. The centrally restricted diffusion sign on MRI for assessment of radiation necrosis in metastases treated with stereotactic radiosurgery. J Neurooncol 2021; 155:325-333. [PMID: 34689307 PMCID: PMC8651583 DOI: 10.1007/s11060-021-03879-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/16/2021] [Indexed: 11/29/2022]
Abstract
Purpose Differentiation of radiation necrosis from tumor progression in brain metastases treated with stereotactic radiosurgery (SRS) is challenging. For this, we assessed the performance of the centrally restricted diffusion sign. Methods Patients with brain metastases treated with SRS who underwent a subsequent intervention (biopsy/resection) for a ring-enhancing lesion on preoperative MRI between 2000 and 2020 were included. Excluded were lesions containing increased susceptibility limiting assessment of DWI. Two neuroradiologists classified the location of the diffusion restriction with respect to the post-contrast T1 images as centrally within the ring-enhancement (the centrally restricted diffusion sign), peripherally correlating to the rim of contrast enhancement, both locations, or none. Measures of diagnostic accuracy and 95% CI were calculated for the centrally restricted diffusion sign. Cohen's kappa was calculated to identify the interobserver agreement. Results Fifty-nine patients (36 female; mean age 59, range 40 to 80) were included, 36 with tumor progression and 23 with radiation necrosis based on histopathology. Primary tumors included 34 lung, 12 breast, 5 melanoma, 3 colorectal, 2 esophagus, 1 head and neck, 1 endometrium, and 1 thyroid. The centrally restricted diffusion sign was seen in 19/23 radiation necrosis cases (sensitivity 83% (95% CI 63 to 93%), specificity 64% (95% CI 48 to 78%), PPV 59% (95% CI 42 to 74%), NPV 85% (95% CI 68 to 94%)) and 13/36 tumor progression cases (difference p < 0.001). Interobserver agreement was substantial, at 0.61 (95% CI 0.45 to 70.8). Conclusion We found a low probability of radiation necrosis in the absence of the centrally restricted diffusion sign.
Collapse
Affiliation(s)
- Nicolin Hainc
- Department of Medical Imaging, University of Toronto, Toronto, Canada. .,Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| | - Noor Alsafwani
- Laboratory Medicine Program, University Health Network, Toronto, Canada.,Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia
| | - Andrew Gao
- Laboratory Medicine Program, University Health Network, Toronto, Canada
| | | | - Paul Kongkham
- Neurosurgery, University Health Network, Toronto, Canada
| | - Gelareh Zadeh
- Neurosurgery, University Health Network, Toronto, Canada
| | - Enrique Gutierrez
- Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - David Shultz
- Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Timo Krings
- Department of Medical Imaging, University of Toronto, Toronto, Canada.,Joint Department of Medical Imaging, University Health Network, Toronto, Canada
| | - Paula Alcaide-Leon
- Department of Medical Imaging, University of Toronto, Toronto, Canada.,Joint Department of Medical Imaging, University Health Network, Toronto, Canada
| |
Collapse
|
49
|
Klostranec JM, Vucevic D, Bhatia KD, Kortman HGJ, Krings T, Murphy KP, terBrugge KG, Mikulis DJ. Current Concepts in Intracranial Interstitial Fluid Transport and the Glymphatic System: Part I-Anatomy and Physiology. Radiology 2021; 301:502-514. [PMID: 34665028 DOI: 10.1148/radiol.2021202043] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Normal physiologic function of organs requires a circulation of interstitial fluid to deliver nutrients and clear cellular waste products. Lymphatic vessels serve as collectors of this fluid in most organs; however, these vessels are absent in the central nervous system. How the central nervous system maintains tight control of extracellular conditions has been a fundamental question in neuroscience until recent discovery of the glial-lymphatic, or glymphatic, system was made this past decade. Networks of paravascular channels surrounding pial and parenchymal arteries and veins were found that extend into the walls of capillaries to allow fluid transport and exchange between the interstitial and cerebrospinal fluid spaces. The currently understood anatomy and physiology of the glymphatic system is reviewed, with the paravascular space presented as an intrinsic component of healthy pial and parenchymal cerebral blood vessels. Glymphatic system behavior in animal models of health and disease, and its enhanced function during sleep, are discussed. The evolving understanding of glymphatic system characteristics is then used to provide a current interpretation of its physiology that can be helpful for radiologists when interpreting neuroimaging investigations.
Collapse
Affiliation(s)
- Jesse M Klostranec
- From the Montreal Neurologic Institute and Hospital, Department of Diagnostic and Interventional Neuroradiology, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montreal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montreal, Montréal, Canada (J.M.K.); Department of Materials Science & Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, Canada (D.V.); Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.); and Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada (T.K., K.G.t.B.)
| | - Diana Vucevic
- From the Montreal Neurologic Institute and Hospital, Department of Diagnostic and Interventional Neuroradiology, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montreal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montreal, Montréal, Canada (J.M.K.); Department of Materials Science & Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, Canada (D.V.); Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.); and Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada (T.K., K.G.t.B.)
| | - Kartik D Bhatia
- From the Montreal Neurologic Institute and Hospital, Department of Diagnostic and Interventional Neuroradiology, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montreal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montreal, Montréal, Canada (J.M.K.); Department of Materials Science & Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, Canada (D.V.); Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.); and Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada (T.K., K.G.t.B.)
| | - Hans G J Kortman
- From the Montreal Neurologic Institute and Hospital, Department of Diagnostic and Interventional Neuroradiology, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montreal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montreal, Montréal, Canada (J.M.K.); Department of Materials Science & Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, Canada (D.V.); Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.); and Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada (T.K., K.G.t.B.)
| | - Timo Krings
- From the Montreal Neurologic Institute and Hospital, Department of Diagnostic and Interventional Neuroradiology, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montreal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montreal, Montréal, Canada (J.M.K.); Department of Materials Science & Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, Canada (D.V.); Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.); and Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada (T.K., K.G.t.B.)
| | - Kieran P Murphy
- From the Montreal Neurologic Institute and Hospital, Department of Diagnostic and Interventional Neuroradiology, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montreal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montreal, Montréal, Canada (J.M.K.); Department of Materials Science & Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, Canada (D.V.); Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.); and Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada (T.K., K.G.t.B.)
| | - Karel G terBrugge
- From the Montreal Neurologic Institute and Hospital, Department of Diagnostic and Interventional Neuroradiology, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montreal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montreal, Montréal, Canada (J.M.K.); Department of Materials Science & Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, Canada (D.V.); Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.); and Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada (T.K., K.G.t.B.)
| | - David J Mikulis
- From the Montreal Neurologic Institute and Hospital, Department of Diagnostic and Interventional Neuroradiology, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montreal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montreal, Montréal, Canada (J.M.K.); Department of Materials Science & Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, Canada (D.V.); Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.); and Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada (T.K., K.G.t.B.)
| |
Collapse
|
50
|
Qaiser F, Sadoway T, Yin Y, Zulfiqar Ali Q, Nguyen CM, Shum N, Backstrom I, Marques PT, Tabarestani S, Munhoz RP, Krings T, Pearson CE, Yuen RKC, Andrade DM. Genome sequencing identifies rare tandem repeat expansions and copy number variants in Lennox-Gastaut syndrome. Brain Commun 2021; 3:fcab207. [PMID: 34622207 PMCID: PMC8491034 DOI: 10.1093/braincomms/fcab207] [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: 05/10/2021] [Revised: 07/23/2021] [Accepted: 07/29/2021] [Indexed: 11/22/2022] Open
Abstract
Epilepsies are a group of common neurological disorders with a substantial
genetic basis. Despite this, the molecular diagnosis of epilepsies remains
challenging due to its heterogeneity. Studies utilizing whole-genome sequencing
may provide additional insights into genetic causes of epilepsies of unknown
aetiology. Whole-genome sequencing was used to evaluate a cohort of adults with
unexplained developmental and epileptic encephalopathies (n
= 30), for whom prior genetic tests, including whole-exome sequencing in
some cases, were negative or inconclusive. Rare single nucleotide variants,
insertions/deletions, copy number variants and tandem repeat expansions were
analysed. Seven pathogenic or likely pathogenic single nucleotide variants, and
two pathogenic deleterious copy number variants were identified in nine patients
(32.1% of the cohort). One of the copy number variants, identified in a
patient with Lennox–Gastaut syndrome, was too small to be detected by
chromosomal microarray techniques. We also identified two tandem repeat
expansions with clinical implications in two other patients with
Lennox–Gastaut syndrome: a CGG repeat expansion in the
5′untranslated region of DIP2B, and a CTG expansion in
ATXN8OS (previously implicated in spinocerebellar ataxia
type 8). Three patients had KCNA2 pathogenic variants. One of
them died of sudden unexpected death in epilepsy. The other two patients had, in
addition to a KCNA2 variant, a second de novo
variant impacting potential epilepsy-relevant genes (KCNIP4 and
UBR5). Overall, whole-genome sequencing provided a genetic
explanation in 32.1% of the total cohort. This is also the first report
of coding and non-coding tandem repeat expansions identified in patients with
Lennox–Gastaut syndrome. This study demonstrates that using whole-genome
sequencing, the examination of multiple types of rare genetic variation,
including those found in the non-coding region of the genome, can help resolve
unexplained epilepsies.
Collapse
Affiliation(s)
- Farah Qaiser
- Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Genetics & Genome Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada.,Adult Epilepsy Genetics Research Program, Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Tara Sadoway
- Adult Epilepsy Genetics Research Program, Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Yue Yin
- Genetics & Genome Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Quratulain Zulfiqar Ali
- Adult Epilepsy Genetics Research Program, Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Charlotte M Nguyen
- Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Genetics & Genome Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Natalie Shum
- Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Genetics & Genome Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Ian Backstrom
- Genetics & Genome Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Paula T Marques
- Adult Epilepsy Genetics Research Program, Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Sepideh Tabarestani
- Adult Epilepsy Genetics Research Program, Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Renato P Munhoz
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada.,Neuromodulation Unit and Ataxia Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Timo Krings
- Department of Medical Imaging, University of Toronto, Toronto, Canada.,Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Christopher E Pearson
- Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Genetics & Genome Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Ryan K C Yuen
- Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Genetics & Genome Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Danielle M Andrade
- Adult Epilepsy Genetics Research Program, Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Toronto, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada.,Epilepsy Program, Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
| |
Collapse
|