المؤلفون: Scherschinski, Lea, Srinivasan, Visish M, Karahalios, Katherine, Garcia, Joseph H, Koester, Stefan W, Jubran, Jubran H, Benner, Dimitri, Winkler, Ethan A, Catapano, Joshua S, Labib, Mohamed A, Graffeo, Christopher S, Lawton, Michael T

المصدر: Neurosurgery

مصطلحات موضوعية: Brain arteriovenous malformation, Cerebrovascular, Medial, Orbitozygomatic, Tangential, Temporal lobe, Transcortical, Humans, Male, Adult, Female, Intracranial Arteriovenous Malformations (diagnostic imaging, surgery, pathology), Treatment Outcome, Retrospective Studies, Quality of Life, Brain (pathology)

الوصف: OBJECTIVE: Microsurgical resection of medial temporal brain arteriovenous malformations (AVMs) is typically conducted through 2 approaches: the orbitozygomatic-tangential and subtemporal-transcortical. Relative indications and outcomes for these techniques have not been formally compared. METHODS: The cerebrovascular database of a quaternary center was reviewed for patients with medial temporal AVMs treated between January 1, 1997, and July 31, 2021. Demographic characteristics, lesion characteristics, surgical approaches, and outcomes were retrospectively analyzed and compared. Postoperative outcome testing was performed using the Montreal Cognitive Assessment and Global Quality of Life Scale. RESULTS: Fifty-nine patients were assessed. Mean (standard deviation) age was 31 (18) years; 30 (51%) patients were male. Of the AVMs, 29 (49%) were left-sided and 30 (51%) were right-sided. The tangential approach was selected in 20 (34%) cases, whereas the transcortical technique was preferred in 39 (66%). Improved modified Rankin Scale status was significantly associated with the tangential resection technique both in the early postoperative period (P = 0.02) and at last follow-up (P = 0.01). Differences between the tangential and transcortical approaches were not significant with respect to new postoperative deficits (5/20 [25%] vs. 12/39 [31%], P = 0.87) or the presence of residual AVM on follow-up angiography (1/20 [6%] vs. 5/39 [14%], P = 0.65). CONCLUSIONS: The orbitozygomatic-tangential strategy was associated with favorable functional and quality-of-life outcomes after medial temporal AVM resection. These benefits are likely to be attributable to minimization of temporal retraction, avoidance of brain transgression, and avoidance of traction on the vein of Labbé, rendering the orbitozygomatic-tangential approach the preferred option for cases that are anatomically amenable to either strategy.

العلاقة: https://scholar.barrowneuro.org/neurosurgery/1851Test; https://doi.org/10.1016/j.wneu.2023.02.005Test

الإتاحة: https://doi.org/10.1016/j.wneu.2023.02.005Test
https://scholar.barrowneuro.org/neurosurgery/1851Test

المؤلفون: Srinivasan, Visish M, Karahalios, Katherine, Reddy, Vamsi P, Scherschinski, Lea, DiDomenico, Joseph D, Rahmani, Redi, Catapano, Joshua S, Labib, Mohamed A, Rumalla, Kavelin, Graffeo, Christopher S, Lawton, Michael T

المصدر: Neurosurgery

مصطلحات موضوعية: aneurysm, arteriovenous fistula, arteriovenous malformation, cerebrovascular, complex cranial, infraoccipital, skull base, supratentorial, surgical technique, vascular disorders, Humans, Cohort Studies, Intracranial Arteriovenous Malformations (surgery), Arteriovenous Fistula (surgery), Occipital Lobe (blood supply), Brain, Treatment Outcome, Retrospective Studies

الوصف: OBJECTIVE: The objective of this paper was to assess applications of the supratentorial-infraoccipital (STIO) approach for cerebrovascular neurosurgery. METHODS: The authors conducted a cohort study of all consecutive cases in which the STIO approach was used during the study period, December 1995 to January 2021, as well as a systematic review of the literature. RESULTS: Twenty-five cerebrovascular cases were identified in which the STIO approach was used. Diagnoses included arteriovenous malformation (n = 15), cerebral cavernous malformation (n = 5), arteriovenous fistula (n = 4), and aneurysm (n = 1). The arteriovenous malformations consisted of Spetzler-Martin grade II (n = 3), grade III (n = 8), and grade IV (n = 4) lesions. Lesion locations included the occipital lobe (n = 15), followed by the tentorial dural (n = 4), temporal-occipital (n = 3), temporal (n = 1), thalamic (n = 1), and quadrigeminal cistern (n = 1) regions. Many patients (75%) experienced transient visual deficits attributable to retraction of the occipital lobe, all of which resolved. As of last follow-up (n = 12), modified Rankin Scale scores had improved for 6 patients and were unchanged for 6 patients compared with the preoperative baseline. CONCLUSIONS: The STIO approach is a safe and effective skull base approach that provides a specialized access corridor for appropriately selected cerebrovascular lesions.

العلاقة: https://scholar.barrowneuro.org/neurosurgery/1779Test; https://doi.org/10.3171/2022.5.JNS22506Test

الإتاحة: https://doi.org/10.3171/2022.5.JNS22506Test
https://scholar.barrowneuro.org/neurosurgery/1779Test

المؤلفون: Srinivasan, Visish M, Karahalios, Katherine, Shlobin, Nathan A, Koester, Stefan W, Nguyen, Candice L, Rumalla, Kavelin, Rahmani, Redi, Catapano, Joshua S, Labib, Mohamed A, Mitha, Alim P, Spetzler, Robert F, Lawton, Michael T

المصدر: Neurosurgery

مصطلحات موضوعية: Male, Humans, Female, Adolescent, Young Adult, Adult, Middle Aged, Aged, Retrospective Studies, Treatment Outcome, Hemangioma, Cavernous, Central Nervous System (diagnostic imaging, surgery), Neurosurgical Procedures (methods), Spinal Cord (diagnostic imaging

الوصف: BACKGROUND: Intramedullary spinal cord cavernous malformations (SCCMs) account for only 5% of overall cavernous malformations (CMs). The occurrence of recurrent or residual SCCMs has not been well discussed, nor have the technical nuances of resection. OBJECTIVE: To assess the characteristics of residual SCCMs and surgical outcomes and describe the techniques to avoid leaving lesion remnants during primary resection. METHODS: Demographic, radiologic, intraoperative findings and surgical outcomes data for a cohort of surgically managed intramedullary SCCMs were obtained from an institutional database and retrospectively analyzed. A systematic literature review was performed using PRISMA guidelines. RESULTS: Of 146 SCCM resections identified, 17 were for residual lesions (12%). Patients with residuals included 13 men and 4 women, with a mean age of 43 years (range 16-70). All patients with residual SCCMs had symptomatic presentations: sensory deficits, paraparesis, spasticity, and pain. Residuals occurred between 3 and 264 months after initial resection. Approaches for 136 cases included posterior midline myelotomy (28.7%, n = 39), pial surface entry (37.5%, n = 51), dorsal root entry zone (27.9%, n = 38), and lateral entry (5.9%, n = 8). Follow-up outcomes were similar for patients with primary and residual lesions, with the majority having no change in modified Rankin Scale score (63% [59/93] vs 75% [9/12], respectively, P = .98). CONCLUSION: SCCMs may cause significant symptoms. During primary resection, care should be taken to avoid leaving residual lesion remnants, which can lead to future hemorrhagic events and neurological morbidity. However, satisfactory results are achievable even with secondary or tertiary resections.

العلاقة: https://scholar.barrowneuro.org/neurosurgery/1833Test; https://doi.org/10.1227/ons.0000000000000456Test

الإتاحة: https://doi.org/10.1227/ons.0000000000000456Test
https://scholar.barrowneuro.org/neurosurgery/1833Test

المؤلفون: Catapano, Joshua S, Srinivasan, Visish M, Rumalla, Kavelin, Koester, Stefan W, Kimata, Anna R, Ma, Kevin L, Labib, Mohamed A, Baranoski, Jacob F, Cole, Tyler S, Rutledge, Caleb, Ducruet, Andrew F, Albuquerque, Felipe C, Spetzler, Robert F, Lawton, Michael T

المصدر: Neurosurgery

مصطلحات موضوعية: Cohort Studies, Embolization, Therapeutic, Humans, Intracranial Arteriovenous Malformations (surgery), Propensity Score, Radiosurgery, Retrospective Studies, Treatment Outcome

الوصف: BACKGROUND: Cerebral arteriovenous malformations (AVMs) with low Spetzler-Martin grades (I and II) are associated with good neurological outcomes after microsurgical resection; however, the use of preoperative embolization for these lesions is controversial. OBJECTIVE: To compare the neurological outcomes of preoperative embolization with no embolization in patients with low-grade AVMs. METHODS: Patients with a Spetzler-Martin grade I or II AVM who underwent microsurgical resection during January 1, 1997, through December 31, 2019, were analyzed. Patients undergoing preoperative embolization were compared with patients not undergoing embolization. A propensity score was constructed from baseline characteristics and used to match intervention (embolization) and control (nonembolization) groups in a 1:1 ratio. The primary outcome was poor neurological status on last follow-up examination, defined as a modified Rankin Scale score >2 and a modified Rankin Scale score worse at follow-up than at the preoperative examination. RESULTS: Of the 603 patients analyzed, 310 (51.4%) underwent preoperative embolization and 293 (48.6%) did not. Patients in the embolization cohort compared with those in the nonembolization cohort had a higher percentage of Spetzler-Martin grade II AVMs (71.6% vs 52.6%, P < .001) and a lower percentage of hemorrhage (41% vs 55%, P = .001). After propensity score matching, no differences were found between paired cohorts (each N = 203) for baseline characteristics with a significant reduction in absolute standardized mean differences. No significant differences were found in primary outcomes between treatment groups in the matched or unmatched cohorts. CONCLUSION: Preoperative embolization of low-grade Spetzler-Martin AVMs is not associated with improved neurological outcomes after microsurgical resection.

العلاقة: https://scholar.barrowneuro.org/neurosurgery/1571Test; https://doi.org/10.1227/NEU.0000000000001741Test

الإتاحة: https://doi.org/10.1227/NEU.0000000000001741Test
https://scholar.barrowneuro.org/neurosurgery/1571Test

المؤلفون: Labib, Mohamed A, Rumalla, Kavelin, Karahalios, Katherine, Srinivasan, Visish M, Nguyen, Candice L, Rahmani, Redi, Catapano, Joshua S, Zabramski, Joseph M, Lawton, Michael T

المصدر: Neurosurgery

مصطلحات موضوعية: Aneurysm, Ruptured (complications), Costs and Cost Analysis, Endovascular Procedures, Humans, Intracranial Aneurysm (complications), Microsurgery (adverse effects), Retrospective Studies, Subarachnoid Hemorrhage (complications), Treatment Outcome

الوصف: BACKGROUND: In specialized neurosurgical centers, open microsurgery is routinely performed for aneurysmal subarachnoid hemorrhage (aSAH). OBJECTIVE: To compare the cost of endovascular vs microsurgical treatment for aSAH at a single quaternary center. METHODS: All patients undergoing aSAH treatment from July 1, 2014, to July 31, 2019, were retrospectively reviewed. Patients were grouped based on primary treatment (microsurgery vs endovascular treatment). The primary outcome was the difference in total cost (including hospital, discharge facility, and all follow-up) using a propensity-adjusted analysis. RESULTS: Of 384 patients treated for an aSAH, 234 (61%) were microsurgically treated and 150 (39%) were endovascularly treated. The mean cost of index hospitalization for these patients was marginally higher ($9504) for endovascularly treated patients ($103 980) than for microsurgically treated patients ($94 476) ( P = .047). For the subset of patients with follow-up data available, the mean total cost was $45 040 higher for endovascularly treated patients ($159 406, n = 59) than that for microsurgically treated patients ($114 366, n = 105) ( P < .001). After propensity scoring (adjusted for age, sex, comorbidities, Glasgow Coma Scale score, Hunt and Hess grade, Fisher grade, aneurysms, and type/size/location), linear regression analysis of patients with follow-up data available revealed that microsurgery was independently associated with healthcare costs that were $37 244 less than endovascular treatment costs ( P < .001). An itemized cost analysis suggested that this discrepancy was due to differences in the rates of aneurysm retreatment and long-term surveillance. CONCLUSION: Microsurgical treatment for aSAH is associated with lower total healthcare costs than endovascular therapy. Aneurysm surveillance after endovascular treatments, retreatment, and device costs warrants attention in future studies.

العلاقة: https://scholar.barrowneuro.org/neurosurgery/1792Test; https://doi.org/10.1227/neu.0000000000002061Test

الإتاحة: https://doi.org/10.1227/neu.0000000000002061Test
https://scholar.barrowneuro.org/neurosurgery/1792Test

المؤلفون: Hartke, Joelle N, Srinivasan, Visish M, Rahmani, Redi, Catapano, Joshua S, Labib, Mohamed A, Rumalla, Kavelin, Garcia, Joseph H, McDougall, Cameron M, Abla, Adib A, Lawton, Michael T

المصدر: Neurosurgery

مصطلحات موضوعية: Cavernous Sinus, Central Nervous System Vascular Malformations (diagnostic imaging, pathology, surgery), Embolization, Therapeutic (methods), Humans, Intracranial Hemorrhages (therapy), Retrospective Studies

الوصف: BACKGROUND: Dural arteriovenous fistulas (DAVFs) of the sphenoparietal sinus or sphenoid wing region are uncommon lesions with unique and interesting angioarchitecture. Understanding appropriate anatomy and recognizing patterns provide important treatment implications. OBJECTIVE: To describe a single surgeon's experience with open surgical treatment of sphenoparietal sinus DAVFs, the surgical indications for this uncommon lesion, and the microsurgical techniques related to its treatment and to review the literature on its surgical treatment. METHODS: Consecutive cases of sphenoparietal sinus DAVF treatment conducted by a single surgeon over 24 years (1997-2020) were retrospectively reviewed. Published reports of similar cases were reviewed. RESULTS: Of 202 surgically treated DAVFs, 10 lesions in 10 patients were sphenoparietal sinus DAVFs. Four patients presented with intracranial hemorrhage, 3 with headache, and 2 with pulsatile tinnitus; 1 patient was incidentally identified as having a DAVF during treatment for a ruptured aneurysm. Most patients (7 of 10) had undergone endovascular embolization previously. Nine patients had Borden type III DAVFs and one had a Borden type II fistula. Surgery in all 10 patients resulted in angiographically confirmed fistula obliteration. Clinical outcomes at the last follow-up, measured by a modified Rankin Scale (mRS) score, were excellent in 6 patients (mRS ≤ 2) and poor in 1 patient (mRS ≥ 3); late outcomes were not available for 3 patients. CONCLUSION: Sphenoparietal sinus DAVFs are an uncommon anatomic subtype. Careful attention to angiographic detail leads to identification of the site of venous interruption and results in a high rate of surgical cure with excellent clinical outcomes.

العلاقة: https://scholar.barrowneuro.org/neurosurgery/1838Test; https://doi.org/10.1227/ons.0000000000000269Test

الإتاحة: https://doi.org/10.1227/ons.0000000000000269Test
https://scholar.barrowneuro.org/neurosurgery/1838Test

المؤلفون: Catapano, Joshua S, Srinivasan, Visish M, Labib, Mohamed A, Rumalla, Kavelin, Nguyen, Candice L, Rahmani, Redi, Baranoski, Jacob F, Cole, Tyler S, Rutledge, Caleb, Jadhav, Ashutosh P, Ducruet, Andrew F, Albuquerque, Felipe C, Zabramski, Joseph M, Lawton, Michael T

المصدر: Neurosurgery

مصطلحات موضوعية: Aneurysmal subarachnoid hemorrhage, Charlson Comorbidity Index, Comorbidity, Hunt and Hess grade, Neurologic deficit, Preexisting condition, aSAH, Hospital Mortality, Humans, Retrospective Studies, Subarachnoid Hemorrhage (epidemiology, surgery), Treatment Outcome

الوصف: BACKGROUND: Nationwide study results have suggested varying trends in the incidence of aneurysmal subarachnoid hemorrhage (aSAH) over time. Herein, trends over time for aSAH treated at a quaternary care center are compared with low-volume hospitals. METHODS: Cases were retrospectively reviewed for patients with aSAH treated at our institution. Trend analyses were performed on the number of aSAH hospitalizations, treatment type, Charlson Comorbidity Index (CCI), Hunt and Hess grade, aneurysm location, aneurysm type, and in-hospital mortality. The National Inpatient Sample (NIS) was queried to compare the CCI scores of our patients with those of patients in low-volume hospitals (<20 aSAH/year) in our census division. RESULTS: Some 1248 patients (321 during 2004-2006; 927 during 2008-2018) hospitalized with aSAH were treated with endovascular therapy (489, 39%) or microsurgery (759, 61%). A significant downtrend in the annual aSAH caseload occurred (123 patients in 2004, 75 in 2018, P < 0.001). A linear uptrend was observed for the mean CCI score of patients (R = 0.539, P < 0.001), with no change to in-hospital mortality (R = 0.220, P = 0.24). Mean (standard deviation) CCI for small-volume hospitals treating aSAH within our division was significantly lower than that of our patient population (1.8 [1.6] vs 2.1 [2.0]) for 2012-2015. CONCLUSIONS: A decreasing number of patients were hospitalized with aSAH throughout the study. Compared with patients with aSAH admitted in 2004, those admitted more recently were sicker in terms of preexisting comorbidity and neurologic complexity. These trends could be attributable to the increasing availability of neurointerventional services at smaller-volume hospitals capable of treating healthier patients.

العلاقة: https://scholar.barrowneuro.org/neurosurgery/1597Test; https://doi.org/10.1016/j.wneu.2022.01.088Test

الإتاحة: https://doi.org/10.1016/j.wneu.2022.01.088Test
https://scholar.barrowneuro.org/neurosurgery/1597Test

المؤلفون: Catapano, Joshua S, Whiting, Alexander C, Mezher, Andrew W, Przybylowski, Colin J, See, Alfred P, Labib, Mohamed A, Fredrickson, Vance L, Cavalcanti, Daniel D, Lawton, Michael T., Ducruet, Andrew F., Albuquerque, Felipe C., Sanai, Nader

المصدر: Neurosurgery

مصطلحات موضوعية: Angiography, Blood Loss, Surgical, Contrast Media, Embolization, Therapeutic, Female, Humans, Magnetic Resonance Imaging, Male, Meningeal Neoplasms, Meningioma, Middle Aged, Preoperative Care, Retrospective Studies

الوصف: BACKGROUND: Preoperative embolization of meningiomas to reduce tumor vascularity and intraoperative blood loss remains controversial. Incomplete devascularization on angiography is not significantly correlated with intraoperative estimated blood loss (EBL). Magnetic resonance imaging (MRI) may provide a better assessment of devascularization and prediction of EBL. METHODS: We retrospectively analyzed patients undergoing preoperative embolization for intracranial meningiomas. Cohorts based on postembolization devascularization (>50% vs. ≤50%) were compared. RESULTS: Of 84 patients with meningioma undergoing preoperative embolization, 35 (42%) had a postembolization MRI before resection and met study inclusion criteria. The mean tumor diameter was 4.9 ± 1.3 cm, and mean intraoperative EBL was 576 ± 341 mL. Compared with MRI, angiography overestimated devascularization in 22 patients (63%). Using pre- versus postembolization MRIs, 17 (49%) patients had a >50% decrease in enhancement, which was associated with lower mean intraoperative blood loss (444 ± 255 mL) compared with 17 patients with ≤50% devascularization (700 ± 374 mL) (P = 0.03). On angiography, the 22 (63%) patients who demonstrated >50% devascularization during embolization did not statistically differ in intraoperative EBL when compared with 13 (37%) patients with500 mL blood intraoperatively during resection (95% confidence interval 1.6-54, P = 0.01). CONCLUSIONS: Postembolization contrast-enhanced MRI is a better predictor of intraoperative blood loss during meningioma resection than postembolization angiography, which overestimates the degree of embolic devascularization. Postembolization preoperative MRI is warranted for optimal patient management.

العلاقة: https://scholar.barrowneuro.org/neurosurgery/565Test

الإتاحة: https://doi.org/10.1016/j.wneu.2019.12.104Test
https://scholar.barrowneuro.org/neurosurgery/565Test

المؤلفون: Catapano, Joshua S., Whiting, Alexander C., Wang, Derrick J., Hlubek, Randall J., Labib, Mohamed A., Morgan, Clinton D., Brigeman, Scott, Fredrickson, Vance L., Cavalcanti, Daniel D., Smith, Kris A., Ducruet, Andrew F., Albuquerque, Felipe C.

المصدر: Journal of NeuroInterventional Surgery; Feb2020, Vol. 12 Issue 2, p165-169, 5p, 3 Charts

مصطلحات موضوعية: EPILEPSY surgery, TEMPORAL lobe surgery, AMOBARBITAL, BRAIN surgery, CAROTID artery, SEIZURES (Medicine), CLINICAL pathology, HEALTH facilities, HIPPOCAMPUS (Brain), NEUROPSYCHOLOGICAL tests, MEDICAL records, MEMORY disorders, POSTOPERATIVE period, RISK assessment, SPASMS, SURGICAL complications, PRE-tests & post-tests, RETROSPECTIVE studies, DESCRIPTIVE statistics, ACQUISITION of data methodology, POSTERIOR cerebral artery, DISEASE risk factors

مصطلحات جغرافية: ARIZONA

مستخلص: Background The selective posterior cerebral artery (PCA) amobarbital test, or PCA Wada test, is used to predict memory impairment after epilepsy surgery in patients who have previously had a failed internal carotid artery (ICA) amobarbital test. Methods Medical records from 2012 to 2018 were retrospectively reviewed for all patients with seizures who underwent a selective PCA Wada test at our institution following a failed or inconclusive ICA Wada test. standardized neuropsychological testing was performed before and during the Wada procedure and postoperatively in patients who underwent resection. Results Thirty-three patients underwent a selective PCA Wada test, with no complications. Twenty-six patients with medically refractory epilepsy had a seizure focus amenable to selective amygdalohippocampectomy (AHE). six patients (23%, n=26) had a failed PCA Wada test and did not undergo selective AHE, seven (27%) declined surgical resection, leaving 13 patients who underwent subtemporal selective AHE. Hippocampal sclerosis was found in all 13 patients (100%). Twelve patients (92%) subsequently underwent formal neuropsychological testing and all were found to have stable memory. Ten patients (77%) were seizure-free (Engel class i), with average follow-up of 13 months. Conclusion The selective PCA Wada test is predictive of memory outcomes after subtemporal selective AHE in patients with a failed or inconclusive ICA Wada test. Furthermore, given the low risk of complications and potential benefit of seizure freedom, a selective PCA Wada test may be warranted in patients with medically intractable epilepsy who are candidates for a selective AHE and who have a prior failed or inconclusive ICA Wada test. [ABSTRACT FROM AUTHOR]

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