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1
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Abu-Fares O, Adamou A, Lanfermann H, Krauss JK, Al-Afif S, Döring K. Pipeline flow diverter and transvenous coiling for the treatment of direct carotid cavernous sinus fistulae: a retrospective case series. CVIR Endovasc 2025; 8:44. [PMID: 40381127 DOI: 10.1186/s42155-025-00566-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2025] [Accepted: 05/07/2025] [Indexed: 05/19/2025] Open
Abstract
BACKGROUND Carotid cavernous fistulae (CCF) are pathological connections between the carotid arteries and the cavernous sinus. Endovascular procedures are the mainstay treatment for CCF. The aim of this report is to evaluate the efficacy and safety of the combined use of the Pipeline Vantage (PV) flow diverter and transvenous coil embolization in the treatment of CCF. METHODS Retrospective,monocentric analysis of three patients who underwent neurointerventional treatment of clinically symptomatic CCF using a combination of transvenous coil embolization and flow diverter Implantation. Clinical data, the etiology of the CCF and clinical and radiological follow up were evaluated. RESULTS Clinical and radiological follow-up were available at 3 and 12 months. One patient experienced clinical improvement immediatley after the interventions. The other two patients improved within one year after treatment. No symptomatic complications were recorded. One year after the intervention complete CCF occulsion was documented in all cases. CONCLUSIONS We report an initial experience for the treatment of direct CCF using the combination of a new generation Pipeline FD and transvenous coil embolization. The high treatment success rate and low complication rate are encouraging.
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Affiliation(s)
- Omar Abu-Fares
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School Hannover, 30625, Hannover, Germany.
| | - Antonis Adamou
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School Hannover, 30625, Hannover, Germany
| | - Heinrich Lanfermann
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School Hannover, 30625, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, 30625, Hannover, Germany
| | - Shadi Al-Afif
- Department of Neurosurgery, Hannover Medical School, 30625, Hannover, Germany
| | - Katja Döring
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School Hannover, 30625, Hannover, Germany
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2
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Fox AJ, Viñuela Olano F. Gerard Debrun 1929-2023. AJNR Am J Neuroradiol 2025; 46:1061-1062. [PMID: 40274363 DOI: 10.3174/ajnr.a8718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2025]
Affiliation(s)
- Allan J Fox
- Professor Emeritus, University of Toronto, University of Western Ontario, Canada
| | - Fernando Viñuela Olano
- Professor Emeritus in Radiology, University of Califórnia Los Angeles, with the assistance of Agnes Debrun-Gadbois, Waterloo, Ontario, Canada
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3
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Madapoosi A, Sanchez-Forteza A, Mrad TA, McGuire LS, Theiss P, Tshibangu M, Charbel F, Alaraj A. Part 1: Pushing the boundaries of neurointerventional surgery: A historical review of the work of Dr Gerard Debrun. Interv Neuroradiol 2024; 30:854-861. [PMID: 39113496 PMCID: PMC11569736 DOI: 10.1177/15910199241272519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 11/19/2024] Open
Abstract
French-American neurointerventionalist and pioneer, Dr Gerard Debrun, laid the groundwork for treatments which have become irreplaceable in neurointerventional surgery today. This article aims to outline the career of Dr Debrun while highlighting his accomplishments and contributions to the field of neurointerventional surgery. We selected relevant articles from PubMed authored or co-authored by Dr Debrun between 1941 and 2023. All included articles discuss the accomplishments and contributions of Dr Debrun. Dr Debrun began his career in France by investigating neurointerventional techniques, most notably the intravascular Detachable Balloon Catheter (DBC). His work was recognized by renowned neurosurgeon Dr Charles Drake, who recruited him to London, Ontario. Dr Debrun created the foundation for homemade manufacturing of DBCs, building on one of the largest series for use of DBCs in cerebrovascular disease. Dr Debrun spent time as faculty at Massachusetts General Hospital (MGH) and Johns Hopkins Hospital, before arriving at the University of Illinois Chicago (UIC) where he remained until his retirement. Dr Debrun's subsequent contributions included the calibrated-leak balloon catheter, pioneering of glue embolization, setting the foundation for preoperative AVM embolizations, and as an early adopter of the Guglielmi detachable coil (GDC), including mastering the balloon remodeling technique for wide neck aneurysms. Dr Debrun established the first integrated neurointerventional surgery program at UIC, establishing a well sought-after fellowship program. Dr Debrun lectured extensively and was a prolific writer on neurointerventional surgery throughout this career. His contributions established the foundation for several techniques which have since become standard practice in present-day neurointerventional surgery.
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Affiliation(s)
- Adrusht Madapoosi
- Department of Neurosurgery, University of Illinois Chicago, Chicago, IL, USA
| | | | - Tatiana Abou Mrad
- Department of Neurosurgery, University of Illinois Chicago, Chicago, IL, USA
| | - Laura Stone McGuire
- Department of Neurosurgery, University of Illinois Chicago, Chicago, IL, USA
| | - Peter Theiss
- Department of Neurosurgery, University of Illinois Chicago, Chicago, IL, USA
| | - Mpuekela Tshibangu
- Department of Neurosurgery, University of Illinois Chicago, Chicago, IL, USA
| | - Fady Charbel
- Department of Neurosurgery, University of Illinois Chicago, Chicago, IL, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois Chicago, Chicago, IL, USA
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Gravino G. The pioneering past and cutting-edge future of interventional neuroradiology. Interv Neuroradiol 2024; 30:768-777. [PMID: 36214159 PMCID: PMC11569488 DOI: 10.1177/15910199221130234] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/15/2022] [Indexed: 02/18/2024] Open
Abstract
This review provides a thorough understanding of the developments in the field of interventional neuroradiology (INR). A concise overview of the pioneering past and current state of this field is presented first, followed by a greater emphasis on its future. Five main aspects predicted to undergo significant developments are identified and discussed. These include changes in 'education and training', 'clinical practice and logistics', 'devices and equipment', 'techniques and procedures', and 'relevant diagnostic imaging'. INR is at the crossroads of neuroradiology, neurosurgery, neurology, and the neurosciences. To progress we must value the uniqueness and vitality of this multidisciplinary aspect. While minimal access techniques offer very good anatomical accessibility to treat multiple pathologies of the central nervous system, it is also important to recognise its limitations. Medical, surgical, and radiosurgery modalities retain an important role in the management of some complex neuropathology. This review is certainly not exhaustive of all ongoing and predicted developments, but it is an important update for INR specialists and other interested professionals.
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Affiliation(s)
- Gilbert Gravino
- Neuroradiology Department, The Walton Centre for Neurology and Neurosurgery, Liverpool, L9 7LJ, UK
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5
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Madapoosi A, Sanchez-Forteza A, Mrad TA, McGuire LS, Theiss P, Tshibangu M, Charbel F, Alaraj A. Part 2: The development and advancement of the detachable balloon catheter; a historical and technical review. Interv Neuroradiol 2024:15910199241272531. [PMID: 39109631 PMCID: PMC11571430 DOI: 10.1177/15910199241272531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 11/20/2024] Open
Abstract
The detachable balloon catheter (DBC) was a revolutionary technique for the treatment of cerebrovascular pathologies. It was used to treat carotid cavernous fistulas (CCFs), vertebro-jugular fistulas, arteriovenous malformations (AVMs), and aneurysms. The DBC became the foundation for neurointerventional techniques, leading to the development of coil embolization and bioactives. Our team selected relevant articles from PubMed published between 1974 and 2023. Articles were excluded if they did not discuss the use or development of the detachable balloon catheter or subsequent technologies. The DBC was used to occlude vessels, either temporarily or permanently. Dr Gerard Debrun implemented findings from Dr Fedor Serbinenko's research to develop an intravascular detachable balloon technique. He developed many variations using type I and type II balloon catheters that differed in size, length, and material, allowing for the personalization of treatment based on the lesion. This revolutionary thinking showed that every pathology has a different shape and anatomy that require a unique approach. The DBC would offer the first alternative to the conventional practice of carotid occlusion in CCF treatment at the time. The DBC would later be used in aneurysm occlusion and the embolization of AVMs, with additional benefit in traumatic vascular sacrifice. Although the DBC has largely been replaced, it is still useful in a small subset of patients, and has financial incentive as it is more affordable than coils. This technique was a monumental stride in the history of neurointervention and helped propel the specialty to the current era of patient-specific interventions.
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Affiliation(s)
- Adrusht Madapoosi
- Department of Neurosurgery, University of Illinois Chicago, Chicago, IL, USA
| | | | - Tatiana Abou Mrad
- Department of Neurosurgery, University of Illinois Chicago, Chicago, IL, USA
| | - Laura Stone McGuire
- Department of Neurosurgery, University of Illinois Chicago, Chicago, IL, USA
| | - Peter Theiss
- Department of Neurosurgery, University of Illinois Chicago, Chicago, IL, USA
| | - Mpuekela Tshibangu
- Department of Neurosurgery, University of Illinois Chicago, Chicago, IL, USA
| | - Fady Charbel
- Department of Neurosurgery, University of Illinois Chicago, Chicago, IL, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois Chicago, Chicago, IL, USA
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6
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Seraj FQM, Najafi S, Raaisi AA, Mirbolouk MH, Ebrahimnia F, Shamsi HP, Garivani Y, Zabihyan S, Mowla A, Baharvahdat H. Treatment of Traumatic Direct Carotid-Cavernous Fistula with a BeGraft-Covered Stent. Neurointervention 2024; 19:111-117. [PMID: 38808398 PMCID: PMC11222683 DOI: 10.5469/neuroint.2024.00157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
The widely accepted option for treating traumatic direct carotid-cavernous fistula (dCCF) has been endovascular treatment using detachable balloons, coils, or embolic agents. Covered stent deployment has been applied by a few operators and has shown promising results. This is a retrospective study on patients with dCCF treated by an endovascular approach using BeGraft, a covered stent. In 4 cases, this device was successfully deployed without any complications. Immediate complete occlusion was achieved in 3 patients (75%) after deployment of the covered stents. One patient required transvenous coiling for occlusion of the remaining endoleak. Follow-up imaging demonstrated 100% fistula occlusion with complete internal carotid artery patency. No early or late complications occurred following treatment. In conclusion, the BeGraft-covered stent could be a promising safe and effective alternative option for the endovascular treatment of dCCF.
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Affiliation(s)
- Farid Qoorchi Moheb Seraj
- Department of Neurosurgical, Section of Neurovascular, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sajjad Najafi
- Department of Neurosurgical, Section of Neurovascular, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Neurosurgery, Emam Hospital, Mazandaran University of Medical Sciences, School of Medicine, Sari, Iran
| | - Amira Al Raaisi
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Mohammad Hossein Mirbolouk
- Department of Neurosurgery, Firouzgar Hospital, Iran University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Feizollah Ebrahimnia
- Department of Neurosurgical, Section of Neurovascular, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hashem Pahlavan Shamsi
- Department of Neurosurgical, Section of Neurovascular, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yousef Garivani
- Department of Neurosurgical, Section of Neurovascular, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Zabihyan
- Department of Neurosurgical, Section of Neurovascular, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Humain Baharvahdat
- Department of Neurosurgical, Section of Neurovascular, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
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7
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Voldřich R, Grygar J, Charvát F, Netuka D. Natural course of partially embolized carotid-cavernous fistulas. J Neuroimaging 2024; 34:376-385. [PMID: 38343141 DOI: 10.1111/jon.13192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND AND PURPOSE To present the first study analyzing the clinical and radiological course of carotid-cavernous fistulas (CCFs) following incomplete embolization. The study compares magnetic resonance angiography (MRA) to plain angiography (digital subtraction angiography [DSA]) and investigates the long-term ophthalmological impact of residual fistula. METHODS Fistulas classified as partially embolized after the last endovascular treatment were prospectively followed with DSA, MRA, and ophthalmological examination. Both direct and indirect CCFs were included. RESULTS Twenty-one CCFs were included in the study. Nine (43%) fistulas were direct and 12 (57%) were indirect. A favorable clinical outcome of modified Rankin scale ≤2 was recorded in 19 (90%) patients at the last follow-up. Postinterventional ophthalmologic examinations in 16 patients revealed no negative effects of residual fistulas; five remaining patients refused to undergo further examination. Spontaneous thrombosis and complete occlusion of the CCF were demonstrated in 90% of patients, with a mean time to occlusion of 5.7 ± 4.7 months. Fourteen (66%) patients completed the full imaging follow-up (MRA and DSA). In 21% of these cases, discrepancy between the two imaging modalities was observed-MRA failed to detect persistent fistulas identified by DSA. CONCLUSIONS The goal of CCF treatment is safe and complete embolization. However, if adequate flow reduction is achieved, both direct and indirect CCFs tend to spontaneously thrombose. Residual flow does not result in ophthalmological deterioration until the fistula is completely closed. MRA may not be sufficiently sensitive to detect residues of fistulas including cortical venous drainage. Therefore, complete CCF closure should be confirmed through DSA.
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Affiliation(s)
- Richard Voldřich
- Department of Neurosurgery and Neurooncology, Charles University, First Faculty of Medicine, Military University Hospital, Prague, Czech Republic
| | - Jan Grygar
- Department of Ophthalmology, Charles University, First Faculty of Medicine, Military University Hospital, Prague, Czech Republic
| | - František Charvát
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, Charles University, First Faculty of Medicine, Military University Hospital, Prague, Czech Republic
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8
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Iampreechakul P, Wangtanaphat K, Chuntaroj S, Wattanasen Y, Hangsapruek S, Lertbutsayanukul P, Puthkhao P, Siriwimonmas S. Pseudoaneurysm formation following transarterial embolization of traumatic carotid-cavernous fistula with detachable balloon: An institutional cohort long-term study. World J Radiol 2024; 16:94-108. [PMID: 38690547 PMCID: PMC11056853 DOI: 10.4329/wjr.v16.i4.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The goal of therapy for traumatic carotid-cavernous fistula (TCCF) is the elimination of fistula while maintaining patency of the parent artery. The treatment for TCCF has evolved from surgery to endovascular management using detachable balloons, coils, liquid embolic agents, covered stents, or flow-diverter stent through arterial or venous approaches. Despite the withdrawal of detachable balloons from the market in the United States since 2004, transarterial embolization with detachable balloons has currently remained the best initial treatment for TCCF in several countries. However, the pseudoaneurysm formation following transarterial detachable balloon embolization has rarely been observed in long-term follow-up. AIM To determine the occurrence and long-term follow-up of pseudoaneurysm after transarterial detachable balloon for TCCF. METHODS Between January 2009 and December 2019, 79 patients diagnosed with TCCF were treated using detachable latex balloons (GOLDBAL) of four sizes. Pseudoaneurysm sizes were stratified into five grades for analysis. Initial and follow-up assessments involved computed tomography angiography at 1 month, 6 month, 1 year, and longer intervals for significant cases. Clinical follow-ups occurred semi-annually for 2 years, then annually. Factors analyzed included sex, age, fistula size and location, and balloon size. RESULTS In our cohort of 79 patients treated for TCCF, pseudoaneurysms formed in 67.1%, with classifications ranging from grade 0 to grade 3; no grade 4 or giant pseudoaneurysms were observed. The majority of pseudoaneurysms did not progress in size, and some regressed spontaneously. Calcifications developed in most large pseudoaneurysms over 5-10 years. Parent artery occlusion occurred in 7.6% and recurrent fistulas in 16.5%. The primary risk factors for pseudoaneurysm formation were identified as the use of specific balloon sizes, with balloon SP and No. 6 significantly associated with its occurrence (P = 0.005 and P = 0.002, respectively), whereas sex, age, fistula size, location, and the number of balloons used were not significant predictors. CONCLUSION Pseudoaneurysm formation following detachable balloon embolization for TCCF is common, primarily influenced by the size of the balloon used. Despite this, all patients with pseudoaneurysms remained asymptomatic during long-term follow-up.
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Affiliation(s)
- Prasert Iampreechakul
- Department of Neurosurgery, Neurological Institute of Thailand, Bangkok 10400, Thailand
| | | | - Songpol Chuntaroj
- Department of Neuroradiology, Neurological Institute of Thailand, Bangkok 10400, Thailand
| | - Yodkhwan Wattanasen
- Department of Neuroradiology, Neurological Institute of Thailand, Bangkok 10400, Thailand
| | - Sunisa Hangsapruek
- Department of Neuroradiology, Neurological Institute of Thailand, Bangkok 10400, Thailand
| | | | - Pimchanok Puthkhao
- Department of Medical Services, Neurological Institute of Thailand, Bangkok 10400, Thailand
| | - Somkiet Siriwimonmas
- Department of Radiology, Bumrungrad International Hospital, Bangkok 10110, Thailand
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9
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Voldřich R, Charvát F, Netuka D. Indications for alternative endovascular techniques in carotid-cavernous fistulas: A 20-year single-center experience. Interv Neuroradiol 2024:15910199231217549. [PMID: 38173239 PMCID: PMC11569750 DOI: 10.1177/15910199231217549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND While coiling is considered the standard treatment for carotid-cavernous fistulas (CCFs), studies demonstrating excellent results using new materials, especially flow diverter (FD) stents and liquid embolisates, are becoming more frequent. The indications and effectiveness of these alternative endovascular techniques remain unclear. METHODS A total of 22 direct and 20 indirect CCFs were included in the study. These were further subdivided based on the embolic material used: coils versus FD stents for direct and coils versus liquid embolisates for indirect CCFs. The subgroups were subjected to statistical analysis. RESULTS An angiographic cure was achieved in 88% of all CCFs, 93% of patients' experienced clinical improvement or remained stable. Direct CCFs were treated with coiling (41%) or with both coils and FD stents (55%). One (4%) patient with a direct CCF was treated with FD stent alone. Statistical analysis comparing these subgroups revealed a significantly higher complete occlusion rate immediately after treatment in the coiling subgroup (67% vs. 23%, p = 0.0409). The occlusion rates at the last follow-up were similar (89% vs. 85%). Indirect CCFs were treated with coiling (35%) or liquid embolisates (65%). All three periprocedural ischemic complications were recorded within the liquid subgroup, resulting in a significantly higher clinical deterioration rate (p = 0.0333). CONCLUSION FD stents in direct and liquid embolisates in indirect fistulas did not demonstrate better angiographic or clinical outcomes compared to convetional coiling. Liquid agents carried a higher risk of ischemic complications. Alternative embolization materials should be reserved for CCFs that cannot be treated with simple coiling.
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Affiliation(s)
- Richard Voldřich
- Department of Neurosurgery and Neurooncology, Military University Hospital, Charles University, First Faculty of Medicine in Prague, Prague, Czech Republic
| | - František Charvát
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, Military University Hospital, Charles University, First Faculty of Medicine in Prague, Prague, Czech Republic
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10
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Deshmukh AS, Priola SM, Katsanos AH, Scalia G, Costa Alves A, Srivastava A, Hawkes C. The Management of Intracranial Aneurysms: Current Trends and Future Directions. Neurol Int 2024; 16:74-94. [PMID: 38251053 PMCID: PMC10801587 DOI: 10.3390/neurolint16010005] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/14/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Intracranial aneurysms represent a major global health burden. Rupture of an intracranial aneurysm is a catastrophic event. Without access to treatment, the fatality rate is 50% in the first 30 days. Over the last three decades, treatment approaches for intracranial aneurysms have changed dramatically. There have been improvements in the medical management of aneurysmal subarachnoid haemorrhage, and there has been an evolution of treatment strategies. Endovascular therapy is now the mainstay of the treatment of ruptured intracranial aneurysms based on robust randomised controlled trial data. There is now an expansion of treatment indications for unruptured intracranial aneurysms to prevent rupture with both microsurgical clipping and endovascular treatment. Both microsurgical and endovascular treatment modalities have evolved, in particular with the introduction of innovative endovascular treatment options including flow diversion and intra-saccular flow disruption. These novel therapies allow clinicians to treat more complex and previously untreatable aneurysms. We aim to review the evolution of treatment strategies for intracranial aneurysms over time, and discuss emerging technologies that could further improve treatment safety and functional outcomes for patients with an intracranial aneurysm.
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Affiliation(s)
- Aviraj S. Deshmukh
- Division of Clinical Sciences, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, ON P3E 2C6, Canada;
| | - Stefano M. Priola
- Division of Neurosurgery, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, ON P3E 2C6, Canada;
| | - Aris H. Katsanos
- Division of Neurology, Hamilton General Hospital, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital of National Importance “Garibaldi”, 95126 Catania, Italy;
| | - Aderaldo Costa Alves
- Division of Neurosurgery, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, ON P3E 2C6, Canada;
| | - Abhilekh Srivastava
- Division of Neurology, Hamilton General Hospital, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Christine Hawkes
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M5S 1A1, Canada;
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11
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Beneš V, Bubeníková A, Skalický P, Bradáč O. Treatment of Brain Arteriovenous Malformations. Adv Tech Stand Neurosurg 2024; 49:139-179. [PMID: 38700684 DOI: 10.1007/978-3-031-42398-7_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Brain arteriovenous malformations (AVMs) are a rare entity of vascular anomalies, characteristic of anatomical shunting where arterial blood directly flows into the venous circulation. The main aim of the active treatment policy of brain AVMs is the prevention of haemorrhage. There are well-established treatment strategies that continually improve in their safety and efficacy, primarily due to the advances in imaging modalities, targeted and novel techniques, the development of alternative treatment approaches, and even better experience with the disease itself. There are interesting imaging novelties that may be prospectively applicable in the decision-making and planning of the most effective treatment approach for individual patients with intracranial AVM. Surgery is often considered the first-line treatment; however, each patient should be evaluated individually, and the risks of the active treatment policy should not overcome the benefits of the spontaneous natural history of the disease. All treatment modalities, i.e., surgery, radiosurgery, endovascular embolization, and observation, are justified but need to be meticulously selected for each individual patient in order to deliver the best treatment outcome. This chapter deals with historical and currently applied dogmas, followed by introductions of advances in each available treatment modality of AVM management.
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Affiliation(s)
- Vladimír Beneš
- Department of Neurosurgery and Neurooncology, Military University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Adéla Bubeníková
- Department of Neurosurgery and Neurooncology, Military University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Neurosurgery, Motol University Hospital, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Skalický
- Department of Neurosurgery and Neurooncology, Military University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Neurosurgery, Motol University Hospital, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ondřej Bradáč
- Department of Neurosurgery and Neurooncology, Military University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic.
- Department of Neurosurgery, Motol University Hospital, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
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12
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Bathini A, Qazi Z, Bendok BR. Commentary: Transcavernous Surgical Approach for the Treatment of Carotid-Cavernous Fistula: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:119-120. [PMID: 37850914 DOI: 10.1227/ons.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Abhijith Bathini
- Department of Neurological Surgery, Mayo Clinic, Phoenix , Arizona , USA
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix , Arizona , USA
| | - Zeeshan Qazi
- Department of Neurological Surgery, Mayo Clinic, Phoenix , Arizona , USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix , Arizona , USA
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix , Arizona , USA
- Precision Neuro-Therapeutics Innovation Lab, Mayo Clinic, Phoenix , Arizona , USA
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix , Arizona , USA
- Department of Radiology, Mayo Clinic, Phoenix , Arizona , USA
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13
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Mulcahy T, Ma N, Mitchell K. Endovascular treatment of trigeminal neuralgia with cranial autonomic symptoms due to a right-sided petrous ridge dAVF. Br J Neurosurg 2023; 37:1339-1345. [PMID: 33467937 DOI: 10.1080/02688697.2021.1874295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
Dural arteriovenous fistula represents a rare cause of secondary Trigeminal Neuralgia. To date, there have been 18 reported cases of successful treatment of trigeminal neuralgia with endovascular embolization. Here we describe a unique case of a 51-year-old man with right-sided petrous ridge dural arteriovenous fistula causing ipsilateral V1 pain and cranial autonomic dysfunction. Cerebral angiography confirmed a Cognard type 3 right-sided tentorial dAVF supplied by an enlarged meningo-hypophpyseal vessel from the extradural ICA and by the middle meningeal artery. The fistula drains towards the midline via deep cerebral veins, the internal cerebral vein and the straight sinus with likely variceal compression of the right trigeminal nerve root entry zone. Transarterial Onyx embolization resulted in complete obliteration of the dural arteriovenous fistula with immediate resolution of facial pain and autonomic symptoms. After 24 months, the patient remains symptom-free and has no radiographic or clinical evidence of fistula recurrence. To date, there have been no other cases reported of trigeminal neuralgia with cranial autonomic symptoms or SUNCT syndrome due to a dural arteriovenous fistula. The presence of cranial autonomic symptoms with trigeminal neuralgia or a diagnosis of SUNCT should not deter endovascular treatments of dural arteriovenous fistulas or treatment of other compressive vascular lesions.
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Affiliation(s)
- Thomas Mulcahy
- Department of Neurosurgery, Royal Brisbane and Women's Hospital, Herston, Australia
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Norman Ma
- Department of Neurosurgery, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Kenneth Mitchell
- Department of Interventional Radiology, Royal Brisbane and Women's Hospital, Herston, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
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14
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Tomita T. The evolution of pediatric neurosurgery: reflection of personal experience of the last half-century. Childs Nerv Syst 2023; 39:2571-2582. [PMID: 37486438 DOI: 10.1007/s00381-023-06068-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVES In the past 50 years, pediatric neurosurgery has made tremendous strides, and gained its own identity as a distinct subspecialty. I have personally observed this progress and evolution in pediatric neurosurgery in multiple dimensions, which are described based upon my own experience and reflection. METHODS The development and evolutions of multiple domains of pediatric neurosurgery, including neuroimaging, hydrocephalus, pediatric brain tumor, spinal dysraphism, craniosynostosis, vascular malformation, functional neurosurgery and spinal disorders were reviewed and commented on based upon my own experience and reflection. RESULTS The field of pediatric neurosurgery has grown in all aspects of diagnosis and therapy owing to the introduction of computers, innovative techniques and technologies and new discoveries of scientific data including molecular investigations. CONCLUSION A minimally invasive approach and molecular target therapy are a current trend. The past half century's clinical experience and advances in biomedical knowledge and techniques provide foundation for further improvement in the care of children of the next generation. Prospective artificial intelligence will likely promote further advances in pediatric neurosurgery.
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Affiliation(s)
- Tadanori Tomita
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue, Chicago, Illinois, 60611, USA.
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15
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Kollmar R, De Georgia M. Milestones in the history of neurocritical care. Neurol Res Pract 2023; 5:43. [PMID: 37559106 PMCID: PMC10413505 DOI: 10.1186/s42466-023-00271-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023] Open
Abstract
Over the last century, significant milestones have been achieved in managing critical illness and diagnosing and treating neurological diseases. Building upon these milestones, the field of neurocritical care emerged in the 1980 and 1990 s at the convergence of critical care medicine and acute neurological treatment. This comprehensive review presents a historical account of key developments in neurocritical care in both the United States and Europe, with a special emphasis on German contributions. The scope of the review encompasses: the foundations of neurocritical care, including post-operative units in the 1920s and 30s, respiratory support during the poliomyelitis epidemics in the 40 and 50 s, cardiac and hemodynamic care in the 60 and 70 s, and stroke units in the 80 and 90 s; key innovations including cerebral angiography, computed tomography, and intracranial pressure and multi-modal monitoring; and advances in stroke, traumatic brain injury, cardiac arrest, neuromuscular disorders, meningitis and encephalitis. These advances have revolutionized the management of neurological emergencies, emphasizing interdisciplinary teamwork, evidence-based protocols, and personalized approaches to care.
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Affiliation(s)
- Rainer Kollmar
- Department of Neurology and Neurointensive Care, Darmstadt Academic Hospital, Darmstadt, Germany.
| | - Michael De Georgia
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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16
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Sahoo A, Abdalkader M, Saatci I, Raymond J, Qiu Z, Huo X, Sun D, Weyland CS, Jia B, Zaidat OO, Hu W, Qureshi AI, Miao Z, Nguyen TN. History of Neurointervention. Semin Neurol 2023; 43:454-465. [PMID: 37549692 DOI: 10.1055/s-0043-1771455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
In this review article, we aim to provide a summary of the discoveries and developments that were instrumental in the evolution of the Neurointerventional field. We begin with developments in the advent of Diagnostic Cerebral Angiography and progress to cerebral aneurysm treatment, embolization in AVMs and ischemic stroke treatment. In the process we discuss many persons who were key in the development and maturation of the field. A pivotal aspect to rapid growth in the field has been the multidisciplinary involvement of the different neuroscience specialties and therefore we close out our discussion with excitement about ongoing and future developments in the field with a focus on treatments in the non-cerebrovascular disease realm.
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Affiliation(s)
- Anurag Sahoo
- Department of Neurology/Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Mohamad Abdalkader
- Department of Neurology/Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Isil Saatci
- Department of Interventional Neuroradiology, Private Koru Hospitals, Ankara, Turkey
| | - Jean Raymond
- Department of Radiology, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
| | - Zhongming Qiu
- Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, People's Republic of China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dapeng Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Charlotte S Weyland
- Department of Interventional Neuroradiology, Aachen University Hospital, Aachen, Germany
| | - Baixue Jia
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Osama O Zaidat
- Department of Neuroscience and Stroke Program, Bon Secours Mercy Health St Vincent Hospital, Toledo, Ohio
| | - Wei Hu
- Division of Life Sciences and Medicine, Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, People's Republic of China
| | - Adnan I Qureshi
- Department of Neurology, Zeenat Qureshi Stroke Institute, University of Missouri, Columbia, Missouri
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Thanh N Nguyen
- Department of Neurology/Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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17
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Lee SH, Park H, Lee K, Hwang SH, Lee CH, Kang DH, Go KO. Venous outflow-targeted coil embolization of direct carotid-cavernous fistulas. Interv Neuroradiol 2023; 29:251-259. [PMID: 35238235 PMCID: PMC10369117 DOI: 10.1177/15910199221084787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Coil embolization is the mainstay treatment for carotid-cavernous fistulas (CCFs). However, few studies have reported entire occlusion of engorged veins to interrupt venous outflow. We report our experience with venous outflow-targeted coil embolization of direct CCFs. METHODS We retrospectively reviewed all the patients diagnosed with direct CCFs treated with venous outflow-targeted coil embolization between November 2013 and February 2020. Venous outflow-targeted coil embolization of the CCFs was performed as follows. First, transarterial stent-assisted coil embolization of CCFs was performed. If the venous outflow to the engorged veins persisted after transarterial stent-assisted coil embolization, entire occlusion of the engorged veins and additional coil packing within the cavernous sinus were performed to interrupt the venous outflow. RESULTS Ten patients had undergone venous outflow-targeted coil embolization, 6 women (60%) and 4 men (40%). Transfemoral cerebral angiography showed high-flow, direct CCFs in all the patients. Venous outflow occurred through the superior ophthalmic vein (SOV) in all the patients and was completely interrupted by the entire occlusion of the engorged veins with fibered coils. Three patients (30%) had undergone additional treatment in a supplementary manner because of recurrent symptoms (chemosis in 1 patient, faint tinnitus in 2 patients) in the early postprocedural period (1 to 4 weeks). All the symptoms were resolved on follow-up. No additional recurrence was found during follow-up (1-75 months). No peri-procedural complications were encountered. CONCLUSIONS Venous outflow-targeted coil embolization of CCFs would be a safe and effective treatment method.
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Affiliation(s)
- Sang Hyub Lee
- Department of Neurosurgery, Gyeongsang National University Graduate School of Medicine, Jinju-Si, Gyeongsangnam-do, Republic of Korea
| | - Hyun Park
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju-Si, Gyeongsangnam-do, Republic of Korea
| | - Kwangho Lee
- Department of Neurosurgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Seongsan-gu, Changwon-Si, Gyeongsangnam-do, Republic of Korea
| | - Soo Hyun Hwang
- Department of Neurosurgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Seongsan-gu, Changwon-Si, Gyeongsangnam-do, Republic of Korea
| | - Chul Hee Lee
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju-Si, Gyeongsangnam-do, Republic of Korea
| | - Dong Ho Kang
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju-Si, Gyeongsangnam-do, Republic of Korea
| | - Kyeong-O Go
- Department of Neurosurgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Seongsan-gu, Changwon-Si, Gyeongsangnam-do, Republic of Korea
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18
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Lauzier DC, Huguenard AL, Srienc AI, Cler SJ, Osbun JW, Chatterjee AR, Vellimana AK, Kansagra AP, Derdeyn CP, Cross DT, Moran CJ. A review of technological innovations leading to modern endovascular brain aneurysm treatment. Front Neurol 2023; 14:1156887. [PMID: 37114225 PMCID: PMC10126349 DOI: 10.3389/fneur.2023.1156887] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
Tools and techniques utilized in endovascular brain aneurysm treatment have undergone rapid evolution in recent decades. These technique and device-level innovations have allowed for treatment of highly complex intracranial aneurysms and improved patient outcomes. We review the major innovations within neurointervention that have led to the current state of brain aneurysm treatment.
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Affiliation(s)
- David C. Lauzier
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- *Correspondence: David C. Lauzier ;
| | - Anna L. Huguenard
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Anja I. Srienc
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Samuel J. Cler
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Joshua W. Osbun
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Arindam R. Chatterjee
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Ananth K. Vellimana
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Akash P. Kansagra
- Department of Neurointerventional Surgery, California Center of Neurointerventional Surgery, San Diego, CA, United States
| | - Colin P. Derdeyn
- Department of Radiology, University of Iowa School of Medicine, Iowa City, IA, United States
| | - Dewitte T. Cross
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Christopher J. Moran
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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19
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Voldřich R, Charvát F, Beneš V, Netuka D. What is the most effective method to treat indirect carotid-cavernous fistula? Neurosurg Rev 2022; 46:9. [PMID: 36482213 DOI: 10.1007/s10143-022-01923-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/11/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
To review the most relevant treatment options for indirect carotid-cavernous fistulas (iCCF), cohorts of 20 patients or more published after 2000 were analyzed. Clinical and radiological outcomes, as well as embolization techniques and material, had to be clarified in the study to be considered. Statistical analysis was based on calculating the relative percentage of therapeutic methods or embolic material, followed by calculating parametric and nonparametric correlations. Some 22 studies and 1550 patients were included. Transvenous embolization (TVE) was used in 53% of the patients and was strongly associated with coiling (rw = 0.66, p = 0.0.0012; rs = 0.53, p = 0.0138), transarterial embolization (TAE) was preferred in 11% of the patients and was strongly linked to liquid embolics (rw = 0.44, p = 0.0434;rs = 0.64, p = 0.0018). A combination of TAE and TVE treatment was used in 7% and a combination of embolic materials in 13% of the patients. None of the endovascular techniques or embolization materials showed significant superiority over the others in clinical outcome and obliteration rate. Radiosurgery in 22% and mechanical compression in 5% of patients showed a lower obliteration rate (rw = - 0.48, p = 0.0254; rs = - 0.45, p = 0.0371). The clinical outcomes were comparable to endovascular treatment (EVT). The remaining 2% of the patients were treated by open surgery or a combination of EVT and radiosurgery. Transvenous coiling is the preferred EVT method for iCCF. However, comparable results may be accomplished with TAE using liquid. Radiosurgery may achieve a lower percentage of fistula occlusion, but the clinical results are equal to EVT.
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Affiliation(s)
- Richard Voldřich
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty of Charles University, Prague, Czech Republic.
| | - František Charvát
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - Vladimír Beneš
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty of Charles University, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty of Charles University, Prague, Czech Republic
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20
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Abbas R, Al-Saiegh F, Atallah E, Naamani KE, Tjoumakaris S, Gooch MR, Herial NA, Jabbour P, Rosenwasser RH. Treatment of Intracerebral Vascular Malformations: When to Intervene. Curr Treat Options Neurol 2022. [DOI: 10.1007/s11940-022-00739-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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21
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Iampreechakul P, Liengudom A, Tirakotai W, Wangtanaphat K, Lertbutsayanukul P, Hangsapruek S, Siriwimonmas S. Combined endovascular and microsurgical management of complex traumatic carotid-cavernous fistula: Three case reports. Surg Neurol Int 2022; 13:337. [PMID: 36128157 PMCID: PMC9479571 DOI: 10.25259/sni_308_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/15/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
With the evolution of the endovascular devices, the management of endovascular interventions has become the current standard therapy for traumatic carotid-cavernous fistula (TCCF). However, only endovascular treatment may not be feasible in some patients with atypical TCCF.
Case Description:
We described three complex TCCFs that could not be managed by conventional endovascular methods. The first patient had recurrent TCCF previously treated by muscle embolization and ligation of affected carotid arteries 23 years ago. Another two patients had TCCFs association with large pseudoaneurysm within the sphenoid sinus. In each patient, the fistula was successfully closed by trapping procedure using a combination of endovascular and surgical treatment.
Conclusion:
To reduce costs of treatment, trapping operation by combining surgical and endovascular treatment may be considered as an alternative option for complex TCCF which has some features including chronic stage, preexisting carotid artery ligation, or association with large venous pouch of the cavernous sinus or sphenoid sinus pseudoaneurysm.
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22
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Batjer HH, Kim J, El Ahmadieh TY, Aoun SG, Corona Ruiz JM, Purdy P, Awad IA. Cerebrovascular surgery: from the Wild West through the endovascular revolution. The M. Gazi Yaşargil Lecture at the American Association of Neurological Surgeons 2021 Annual Scientific Meeting. J Neurosurg 2022; 137:599-603. [PMID: 34996043 DOI: 10.3171/2021.10.jns211412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- H Hunt Batjer
- 1Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jun Kim
- 2Department of Neurological Surgery, Westmead Hospital, Sydney, Australia; and
| | - Tarek Y El Ahmadieh
- 1Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Salah G Aoun
- 1Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Juan Mario Corona Ruiz
- 1Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Phillip Purdy
- 1Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Issam A Awad
- 3Department of Neurological Surgery, University of Chicago Medical Center, Chicago, Illinois
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23
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Laurent D, Lucke-Wold B, Leary O, Randall MH, Porche K, Koch M, Chalouhi N, Polifka A, Hoh BL. The Evolution of Endovascular Therapy for Intracranial Aneurysms: Historical Perspective and Next Frontiers. Neurosci Insights 2022; 17:26331055221117560. [PMID: 35924091 PMCID: PMC9340900 DOI: 10.1177/26331055221117560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/18/2022] [Indexed: 11/20/2022] Open
Abstract
The history of cerebral aneurysm treatment has a rich and storied past with multiple notable luminaries contributing insights. The modern era has transitioned from primarily clip ligation to increasing use of endovascular therapy. Even more recently, the use of intrasaccular flow diverters has been introduced for the treatment of wide necked aneurysms. The field is continuing to transform, and bioactive coils and stents have resurfaced as promising adjuvants to promote aneurysm healing. Advanced imaging modalities are being developed that could further advance the endovascular arsenal and allow for porous memory polymer devices to enter the field. This focused review highlights notable historic contributions and advances to the point of futuristic technology that is actively being developed.
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Affiliation(s)
- Dimitri Laurent
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | | | - Owen Leary
- Department of Neurosurgery, Brown University, Providence, RI, USA
| | - Morgan H Randall
- Department of Cardiology, University of Florida, Gainesville, FL, USA
| | - Ken Porche
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock AR, USA
| | - Matthew Koch
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock AR, USA
| | - Nohra Chalouhi
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock AR, USA
| | - Adam Polifka
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock AR, USA
| | - Brian L Hoh
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock AR, USA
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24
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Gál G. Cerebral Aneurysms. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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25
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Arcuri F, Agostini T, Limbucci N, Laiso A, Mangiafico S, Spinelli G, Panisi I, Nappini S. Salvage transorbital approach for the endovascular treatment of carotid cavernous fistulas. Oral Maxillofac Surg 2022; 26:45-51. [PMID: 33821383 DOI: 10.1007/s10006-021-00961-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Carotid cavernous fistulas (CCFs) are abnormal connections between the cavernous sinus (CS) and carotid arteries. In direct CCFs, a transarterial route is often the preferred vascular access; in case of indirect CCFs, the complex anatomy of the feeder vessels and their extra-intracranial anastomosis makes the transarterial embolization challenging and often ineffective. The aim of this study was to review our experience with the transorbital approach to treat patients affected by CCF who have already experienced an endovascular failure procedure, in order to assess this salvage technique feasibility, by analyzing possible risks and complications. METHODS We performed a retrospective study of all patients affected by CCFs who underwent transorbital embolization between February 2017 and February 2019 at our institution. RESULTS All patients (3 cases) tolerated both the retrograde embolization and the direct surgical approach with clinical improvement; the closure of the fistula was complete and verified intraoperatively by angiography. Esthetic result was acceptable in all cases with reduction of the proptosis and the intraocular pressure, and increased visual acuity. There were no complications or clinical recurrence. CONCLUSION Transorbital approach for the endovascular treatment of CCFs is a feasible and safe salvage procedure, which can find indication after other endovascular access failures.
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Affiliation(s)
- Francesco Arcuri
- Unit of Maxillofacial Surgery, IRCCS San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
| | - Tommaso Agostini
- Casa Di Cura San Paolo, Via del Quadrifoglio, 3, 51100, Pistoia, Italy
| | - Nicola Limbucci
- Unit of Interventional Neuroradiology, Careggi Hospital, Largo Piero Palagi 1, 50139, Florence, Italy
| | - Antonio Laiso
- Unit of Interventional Neuroradiology, Careggi Hospital, Largo Piero Palagi 1, 50139, Florence, Italy
| | - Salvatore Mangiafico
- Unit of Interventional Neuroradiology, Careggi Hospital, Largo Piero Palagi 1, 50139, Florence, Italy
| | - Giuseppe Spinelli
- Unit of Maxillofacial Surgery, Careggi Hospital, Largo Piero Palagi 1, 50139, Florence, Italy
| | - Irene Panisi
- Unit of Maxillofacial Surgery, Careggi Hospital, Largo Piero Palagi 1, 50139, Florence, Italy
| | - Sergio Nappini
- Unit of Interventional Neuroradiology, Careggi Hospital, Largo Piero Palagi 1, 50139, Florence, Italy
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26
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Carotid and Intracranial Surgery. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00021-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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27
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Marosfoi M, Orrù E, Rabinovich M, Newman S, Patel NV, Wakhloo AK. Endovascular Treatment of Intracranial Aneurysms. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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28
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Lee JM, Park ES, Kwon SC. Endovascular management of cavernous sinus dural arteriovenous fistulas: Overall review and considerations. J Cerebrovasc Endovasc Neurosurg 2021; 23:293-303. [PMID: 34915607 PMCID: PMC8743823 DOI: 10.7461/jcen.2021.e2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/30/2021] [Indexed: 11/23/2022] Open
Abstract
Cavernous sinus dural arteriovenous fistulas (CSDAVFs) are arteriovenous shunts between small dural branches arising from the external and/or internal carotid arteries and the cavernous sinus (CS). And now a days, endovascular treatment is the treatment of choice in CSDAVF. We review the anatomy and classifications of CSDAVFs, discussing and detailing these considerations in the treatment of CSDAVFs, theoretically and in the light of recent literatures.
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Affiliation(s)
- Jong Min Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Eun Suk Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Soon Chan Kwon
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Abstract
The treatment of intracranial aneurysms (IA) began in the late 19th century. Some degree of controversy has always surrounded the best treatment modality for IA. Cushing and Dandy debated about cervical carotid ligation as the only surgical alternative before the introduction of microsurgical clipping. In the early 21st century, the debate has centered on surgical versus^ endovascular techniques. With the advent of newer endovascular techniques and devices, there has been a dramatic shift in treatment paradigms toward endovascular intervention that is preferred by both physicians and patients. However, there will always be a need for microsurgical cerebrovascular expertise since some aneurysms cannot or should not be embolized. This creates a difficult conundrum as only the most complex of aneurysms will require open surgery, but the lack of volume and training will be a challenge in teaching and maintaining the surgical expertise required to safely treat them. The purpose of this review is to discuss the history of IA treatment and critically evaluate the current state of the art of IA treatment, with a specific focus on the necessary role microsurgical clipping continues to play in the current treatment landscape.
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Affiliation(s)
- Pablo Harker
- From the Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Justin Vranic
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Aman B Patel
- From the Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Li W, Liu Q, Wang H, Zhang H, Liu Q, Hu L, Li H, Dai J, Sun X, Yu H, Wang D. Innovative application of internal carotid artery embolization in salvage endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma: A case-matched comparison. Int Forum Allergy Rhinol 2021; 12:838-848. [PMID: 34773719 DOI: 10.1002/alr.22927] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/14/2021] [Accepted: 11/09/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The efficacy and safety of internal carotid artery (ICA) embolization as a treatment strategy in recurrent nasopharyngeal carcinoma (rNPC) patients with tumors invading the ICA remain unclear. METHODS We enrolled all rNPC patients with tumors invading the ICA, who underwent salvage endoscopic surgery. Using propensity scores to adjust for specific potential prognostic factors, a well-balanced cohort of 42 patients with limited rNPC was formed by matching each patient who underwent ICA embolization (study group) with one who did not (control group). The survival rates and common treatment-related complications were compared between the 2 groups. RESULTS The cohort included patients with the following tumor stages: rT2 (n = 3), rT3 (n = 24), and rT4 (n = 15). During a median follow-up of 15 (range, 2-63) months, the 2-year overall survival and progression-free survival rates were significantly higher in the ICA embolization group than in the ICA nonembolization group (90.5% vs 53.3% and 71.3% vs 33.0%, respectively; and p = 0.022 and p = 0.006, respectively). In addition, the incidence of treatment-related complications, such as nasal obstruction, nasopharyngeal hemorrhage, and nasopharyngeal necrosis, was significantly lower in the ICA embolization group than in the nonembolization group (p = 0.001, p = 0.014, and p = 0.038, respectively). CONCLUSION The innovative application of ICA embolization in endoscopic surgery in patients with rNPC invading the ICA significantly improved patient survival and reduced the risk of treatment-related complications. Therefore, this may be a safe and effective method with the potential to improve outcomes in rNPC patients.
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Affiliation(s)
- Wanpeng Li
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Qiang Liu
- Department of Radiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Huan Wang
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Huangkang Zhang
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Quan Liu
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Li Hu
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Houyong Li
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Jiong Dai
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Cerebrovascular Disease Center, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xicai Sun
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Hongmeng Yu
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China.,Research Units of New Technologies of Endoscopic Surgery in Skull Base Tumor (2018RU003), Chinese Academy of Medical Sciences, Beijing, China
| | - Dehui Wang
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
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Petrov I, Stankov Z, Boychev D, Klissurski M. Use of coronary stent grafts for the treatment of high-flow carotid cavernous fistula. BMJ Case Rep 2021; 14:14/11/e245922. [PMID: 34764121 PMCID: PMC8587380 DOI: 10.1136/bcr-2021-245922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Carotid cavernous fistulas are abnormal communications between the carotid artery or its branches and the cavernous sinus. It can be traumatic or spontaneous. The widely accepted treatment is by detachable balloons. Advancements in the field of endovascular medicine made available other options for the treatment of this condition. Covered stents are widely available and offer preservation of the parent artery while occluding the fistula.
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Affiliation(s)
- Ivo Petrov
- Cardiology, Angiology and Electrophysiology, Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria
| | - Zoran Stankov
- Cardiology, Angiology and Electrophysiology, Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria
| | - Damyan Boychev
- Cardiology, Angiology and Electrophysiology, Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria
| | - Marko Klissurski
- Neurology, Acibadem City Clinic cardiovascular Center, Sofia, Bulgaria
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Hamano E, Satow T, Hori T, Takahashi JC, Kataoka H. A Case of Direct Carotid-Cavernous Fistulae Successfully Treated by Bidirectional Double Catheter Technique: A Technical Note. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:307-312. [PMID: 37501892 PMCID: PMC10370543 DOI: 10.5797/jnet.cr.2021-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/10/2021] [Indexed: 07/29/2023]
Abstract
Objective Ruptured carotid-cavernous aneurysms (CCAs) are known to result in direct carotid-cavernous fistula (CCF). Although endovascular treatment is recognized as the first-line treatment for direct CCF, obliteration is sometimes difficult because of the high-flow shunt. In this report, we present a case of a direct CCF treated by the combination of transarterial and transvenous approaches. Case Presentation A 57-year-old woman presented with conjunctival chemosis, exophthalmos, and tinnitus. Ophthalmological examination revealed increased intraocular pressure. DSA demonstrated a direct CCF due to a right ruptured CCA with retrograde shunted flow through the superior ophthalmic vein (SOV), superficial middle cerebral vein, basal vein of Rosenthal, and middle temporal vein. Two microcatheters were guided into the shunt segment from the internal carotid artery and SOV. In addition, a balloon catheter was placed at the neck of the aneurysm to assist coiling. Coil embolization for the CCF was performed using two microcatheters in the opposite direction, which enabled compact and tight packing of the shunt segment with only six coils. The CCF was eliminated. Two-year-follow-up MRA revealed no recurrence. Conclusion The bidirectional double catheter technique is a useful approach to obliterate a shunt in a short segment with minimal coils.
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Affiliation(s)
- Eika Hamano
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tetsu Satow
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takamitsu Hori
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Jun C Takahashi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Department of Neurosurgery, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Liu Q, Qi C, Wang Y, Su W, Li G, Wang D. Treatment of direct carotid-cavernous fistula with Willis covered stent with midterm follow-up. Chin Neurosurg J 2021; 7:41. [PMID: 34517922 PMCID: PMC8436539 DOI: 10.1186/s41016-021-00256-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background Willis covered stent is the first stent designed exclusively for intracranial vasculature, and its application in carotid-cavernous fistula is limited. The aim is to evaluate the feasibility and efficacy of this device in treating direct carotid-cavernous fistula. Methods Ten consecutive patients with direct carotid-cavernous fistula were treated in our institution with Willis covered stents from September 2013 to December 2015. The characteristics of these patients and the immediate and follow-up results were retrospectively reviewed. Results Of the 10 patients, 8 were treated for the first time, and 2 had been treated elsewhere. Willis covered stents were successfully released in 9 patients. Abnormal arteriovenous shunt disappeared in 6 cases immediately after stent deployment and endoleak occurred in 3 cases. Endoleak disappeared at 6-month angiography follow-up in one case and was sealed with coils through a pre-set microcatheter in another case. Parent artery was sacrificed as endoleak remained despite repeated balloon dilation and a second stent deployment in the third case. All patients got clinical follow-ups for at least 24 months and 7 patients received angiographic follow-up. Symptoms were relieved gradually in all cases except for slight oculomotor paralysis and visual acuity in one case, respectively. In-stent stenosis was found in 1 case, and no recurrence was observed. Conclusions Willis covered stent is feasible for direct carotid-cavernous fistula.
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Affiliation(s)
- Qinglin Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical Universitys, 119#, Nansihua Xi Road, Fengtai District, Beijing, 100050, China
| | - Changjing Qi
- Nursing Department of Qilu Hospital, Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong province, China
| | - Yunyan Wang
- Neurosurgery Department of Qilu Hospital, Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong province, China
| | - Wandong Su
- Neurosurgery Department of Qilu Hospital, Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong province, China
| | - Gang Li
- Neurosurgery Department of Qilu Hospital, Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong province, China
| | - Donghai Wang
- Neurosurgery Department of Qilu Hospital, Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong province, China.
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Kuribara T, Mikami T, Iihoshi S, Hirano T, Sasamori D, Nonaka T, Mikuni N. Virtual test occlusion for assessing ischemic tolerance using computational fluid dynamics. Surg Neurol Int 2021; 12:378. [PMID: 34513145 PMCID: PMC8422534 DOI: 10.25259/sni_439_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ischemic tolerance has been evaluated by the balloon test occlusion (BTO) for cerebral aneurysms and tumors that might require parent artery occlusion during surgery. However, because of its invasiveness, a non-invasive evaluation method is needed. In this study, we assessed the possibility of virtual test occlusion using computational fluid dynamics (CFD) as a non-invasive alternative to BTO for evaluating ischemic tolerance. METHODS Twenty-one patients who underwent BTO were included in the study. Virtual test occlusion was performed using CFD analysis, and the flow rate (FR) and wall shear stress (WSS) of the middle cerebral artery on the occlusion side were calculated. The correlations between these parameters and examination data including the parameters of computed tomography perfusion during BTO were assessed and the cutoff value of CFD parameters for detecting the good collateral group was calculated. RESULTS The FR was strongly correlated with mean transit time (MTT) during BTO and moderately correlated with collateral flow grade based on angiographic appearance. The WSS was moderately correlated with collateral flow grade, mean stump pressure (MSP), and MTT. Furthermore, the FR and WSS were strongly correlated with the total FR and the diameters of the inlet vessels. The cutoff value of FR for detecting the good collateral group was 126.2 mL/min, while that of the WSS was 4.54 Pa. CONCLUSION The parameters obtained through CFD analysis were correlated with collateral flow grade and MSP in addition to MTT. CFD analysis may be useful to evaluate ischemic tolerance as a non-invasive alternative to BTO.
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Affiliation(s)
- Tomoyoshi Kuribara
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Satoshi Iihoshi
- Department of Endovascular Neurosurgery, Saitama Medical University, International Medical Center, Hidaka, Saitama, Japan
| | - Toru Hirano
- Division of Radiology, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Daisuke Sasamori
- Division of Radiology, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Tadashi Nonaka
- Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
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Permana GI, Suroto NS, Al Fauzi A. Clinical Improvement of Patients with Endovascular Treatment in the Traumatic Carotid-Cavernous Fistula. Asian J Neurosurg 2021; 16:376-380. [PMID: 34268168 PMCID: PMC8244704 DOI: 10.4103/ajns.ajns_246_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/04/2020] [Accepted: 09/24/2020] [Indexed: 11/12/2022] Open
Abstract
A carotid-cavernous sinus fistula (CCF) is a clinical condition when there is an abnormal communication between the internal carotid artery, external carotid artery (ECA), or any of their branches to the cavernous sinus. Traumatic CCF (TCCF) is the most common type of all CCFs. This study aims to find clinical improvement of traumatic carotid-cavernous fistulas (TCCF) after endovascular treatment. We predict the degree of clinical recovery in an attempt to make the treatment of TCCF safe and effective. This study reported a series of 28 patients with TCCFs undergoing coiling and ballooning in a period of 3 years, i.e., from December 2014 to December 2017. This is a novel case report about CCF in our country, Indonesia, especially in Surabaya. We performed clinical, angiographical, and radiological assessments before and at regular time periods after the procedure until 6 months. All patients had a partial and complete occlusion of the fistula. Angiographic occlusion of fistula, visualization of the ophthalmic artery, and disappearance of bruit predicted a good clinical outcome. All patients made a recovery at different times, depending on the degree of fistulas and treatment. Improvement in clinical symptoms had a direct correlation with the degree of occlusion. Treatment was divided into coiling and ballooning depending on patient's condition and angiographic examination. Trans femoral cerebral angiography is still very important diagnostic tool in the diagnosis and treatment of TCCFs.
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Affiliation(s)
- Galih Indra Permana
- Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Airlangga University, Surabaya, Indonesia
| | - Nur Setiawan Suroto
- Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Airlangga University, Surabaya, Indonesia
| | - Asra Al Fauzi
- Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Airlangga University, Surabaya, Indonesia
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Yang R, Wu H, Chen B, Sun W, Hu X, Wang T, Guo Y, Qiu Y, Dai J. Balloon Test Occlusion of Internal Carotid Artery in Recurrent Nasopharyngeal Carcinoma Before Endoscopic Nasopharyngectomy: A Single Center Experience. Front Oncol 2021; 11:674889. [PMID: 34295815 PMCID: PMC8290142 DOI: 10.3389/fonc.2021.674889] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/03/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives Endoscopic nasopharyngectomy (ENPG) is a promising way in treating recurrent nasopharyngeal carcinoma (rNPC), but sometimes may require therapeutic internal carotid artery (ICA) occlusion beforehand. Balloon test occlusion (BTO) is performed to evaluate cerebral ischemic tolerance for ICA sacrifice. However, absence of neurological deficits during BTO does not preclude occur of delayed cerebral ischemia after permanent ICA occlusion. In this study, we evaluate the utility of near-infrared spectroscopy (NIRS) regional cerebral oxygen saturation (rSO2) monitoring during ICA BTO to quantify cerebral ischemic tolerance and to identify the valid cut-off values for safe carotid artery occlusion. This study also aims to find out angiographic findings of cerebral collateral circulation to predict ICA BTO results simultaneously. Material and Methods 87 BTO of ICA were performed from November 2018 to November 2020 at authors’ institution. 79 angiographies of collateral flow were performed in time during BTO and classified into several Subgroups and Types according to their anatomic and collateral flow configurations. 62 of 87 cases accepted monitoring of cerebral rSO2. Categorical variables were compared by using Fisher exact tests and Mann–Whitney U tests. Receiver operating characteristic curve analysis was used to determine the most suitable cut-off value. Results The most suitable cut-off △rSO2 value for detecting BTO-positive group obtained through ROC curve analysis was 5% (sensitivity: 100%, specificity: 86%). NIRS rSO2 monitoring wasn’t able to detect BTO false‐negative results (p = 0.310). The anterior Circle was functionally much more important than the posterior Circle among the primary collateral pathways. The presence of secondary collateral pathways was considered as a sign of deteriorated cerebral hemodynamic condition during ICA BTO. In Types 5 and 6, reverse blood flow to the ICA during BTO protected patients from delayed cerebral ischemia after therapeutic ICA occlusion (p = 0.0357). In Subgroup IV, absence of the posterior Circle was significantly associated with BTO-positive results (p = 0.0426). Conclusion Angiography of cerebral collateral circulation during ICA BTO is significantly correlated with ICA BTO results. Angiographic ICA BTO can be performed in conjunction with NIRS cerebral oximeter for its advantage of being noninvasive, real-time, cost-effective, simple for operation and most importantly for its correct prediction of most rSO2 outcomes of ICA sacrifice. However, in order to ensure a safe carotid artery occlusion, more quantitative adjunctive blood flow measurements are recommended when angiography of cerebral collateral circulation doesn’t fully support rSO2 outcome among clinically ICA BTO-negative cases.
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Affiliation(s)
- Renhao Yang
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Wu
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Binghong Chen
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenhua Sun
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiang Hu
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tianwei Wang
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yubin Guo
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yongming Qiu
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiong Dai
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Hurtado P, Garcia-Orellana M, Amaro S, Carrero E, Zarco F, Lopez A, Fabregas N, Valero R. Use of second generation supraglottic airway device for endovascular treatment of unruptured intracranial aneurysms: a retrospective cohort. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2021; 71:408-412. [PMID: 33915196 PMCID: PMC9373688 DOI: 10.1016/j.bjane.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/04/2021] [Accepted: 04/10/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND We aimed to assess the feasibility of using supraglottic devices as an alternative to orotracheal intubation for airway management during anesthesia for endovascular treatment of unruptured intracranial aneurisms in our department over a nine-year period. METHODS Retrospective single center analysis of cases (2010-2018). Primary outcomes: airway management (supraglottic device repositioning, need for switch to orotracheal intubation, airway complications). SECONDARY OUTCOMES aneurysm complexity, history of subarachnoid hemorrhage, hemodynamic monitoring, and perioperative complications. RESULTS We included 187 patients in two groups: supraglottic device 130 (69.5%) and orotracheal intubation 57 (30.5%). No adverse incidents were recorded in 97% of the cases. Three supraglottic device patients required supraglottic device repositioning and 1 supraglottic device patient required orotracheal intubation due to inadequate ventilation. Three orotracheal intubation patients had a bronchospasm or laryngospasm during awakening. Forty-five patients (24.1%) had complex aneurysms or a history of subarachnoid hemorrhage. Thirty-three of them (73.3%) required orotracheal intubation compared to 24 of the 142 (16.9%) with non-complex aneurysms. Two patients in each group died during early postoperative recovery. Two in each group also had intraoperative bleeding. A post-hoc analysis showed that orotracheal intubation was used in 55 patients (44%) in 2010 through 2014 and 2 (3.2%) in 2015 through 2018, parallel to a trend toward less invasive blood pressure monitoring from the earlier to the later period from 34 (27.2%) cases to 5 (8.2%). CONCLUSION Supraglottic device, like other less invasiveness protocols, can be considered a feasible alternative airway management approach in selected patients proposed for endovascular treatment of unruptured intracranial aneurisms.
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Affiliation(s)
- Paola Hurtado
- Hospital Clínic de Barcelona, Anaesthesiology Department, Barcelona, Spain
| | | | - Sergi Amaro
- Hospital Clínic de Barcelona, Neurology Department, Barcelona, Spain
| | - Enrique Carrero
- Hospital Clínic de Barcelona, Anaesthesiology Department, Barcelona, Spain
| | - Federico Zarco
- Hospital Clínic de Barcelona, Radiology Department, Barcelona, Spain
| | - Anna Lopez
- Hospital Clínic de Barcelona, Anaesthesiology Department, Barcelona, Spain
| | - Neus Fabregas
- Hospital Clínic de Barcelona, Anaesthesiology Department, Barcelona, Spain
| | - Ricard Valero
- Hospital Clínic de Barcelona, Anaesthesiology Department, Barcelona, Spain.
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Lonser RR, Smith LGF, Tennekoon M, Rezai-Zadeh KP, Ojemann JG, Korn SJ. Creation of a comprehensive training and career development approach to increase the number of neurosurgeons supported by National Institutes of Health funding. J Neurosurg 2021; 135:176-184. [PMID: 32764178 PMCID: PMC10193408 DOI: 10.3171/2020.5.jns201008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/04/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To increase the number of independent National Institutes of Health (NIH)-funded neurosurgeons and to enhance neurosurgery research, the National Institute of Neurological Disorders and Stroke (NINDS) developed two national comprehensive programs (R25 [established 2009] for residents/fellows and K12 [2013] for early-career neurosurgical faculty) in consultation with neurosurgical leaders and academic departments to support in-training and early-career neurosurgeons. The authors assessed the effectiveness of these NINDS-initiated programs to increase the number of independent NIH-funded neurosurgeon-scientists and grow NIH neurosurgery research funding. METHODS NIH funding data for faculty and clinical department funding were derived from the NIH, academic departments, and Blue Ridge Institute of Medical Research databases from 2006 to 2019. RESULTS Between 2009 and 2019, the NINDS R25 funded 87 neurosurgical residents. Fifty-three (61%) have completed the award and training, and 39 (74%) are in academic practice. Compared to neurosurgeons who did not receive R25 funding, R25 awardees were twice as successful (64% vs 31%) in obtaining K-series awards and received the K-series award in a significantly shorter period of time after training (25.2 ± 10.1 months vs 53.9 ± 23.0 months; p < 0.004). Between 2013 and 2019, the NINDS K12 has supported 19 neurosurgeons. Thirteen (68%) have finished their K12 support and all (100%) have applied for federal funding. Eleven (85%) have obtained major individual NIH grant support. Since the establishment of these two programs, the number of unique neurosurgeons supported by either individual (R01 or DP-series) or collaborative (U- or P-series) NIH grants increased from 36 to 82 (a 2.3-fold increase). Overall, NIH funding to clinical neurological surgery departments between 2006 and 2019 increased from $66.9 million to $157.3 million (a 2.2-fold increase). CONCLUSIONS Targeted research education and career development programs initiated by the NINDS led to a rapid and dramatic increase in the number of NIH-funded neurosurgeon-scientists and total NIH neurosurgery department funding.
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Affiliation(s)
- Russell R. Lonser
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Luke G. F. Smith
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael Tennekoon
- Office of Training and Workforce Development, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; and
| | - Kavon P. Rezai-Zadeh
- Office of Training and Workforce Development, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; and
| | - Jeffrey G. Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Stephen J. Korn
- Office of Training and Workforce Development, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; and
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Suzuki R, Takigawa T, Matsumoto Y, Fujii Y, Nariai Y, Sugiura Y, Kawamura Y, Takano I, Tanaka Y, Nagaishi M, Hyodo A, Suzuki K. Target Coil Embolization Using the Combined Transarterial and Transvenous Balloon-assisted Technique for Traumatic Direct Carotid Cavernous Fistula. NMC Case Rep J 2021; 8:13-19. [PMID: 34012743 PMCID: PMC8116922 DOI: 10.2176/nmccrj.cr.2020-0045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/09/2020] [Indexed: 01/07/2023] Open
Abstract
Herein, we describe a case of traumatic direct carotid cavernous fistula (DCCF) treated with target coil embolization using the combined transarterial and transvenous balloon-assisted technique. The patient was a 59-year-old woman who had been involved in a vehicular accident. She was admitted to the hospital due to chemosis and exophthalmos. Cerebral angiography revealed a shunt from the internal carotid artery (ICA) to the cavernous sinus (CS), which indicated DCCF. Thus, target coil embolization using the combined transarterial and transvenous balloon-assisted technique was performed. Angiography was performed 1 week after surgery to confirm the disappearance of DCCF. No recurrence was observed during the 1-year follow-up after treatment. Thus, target coil embolization using the combined transarterial and transvenous balloon-assisted technique is safe and effective for the treatment of traumatic DCCF.
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Affiliation(s)
- Ryotaro Suzuki
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Tomoji Takigawa
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Yoshiyuki Matsumoto
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Yoshiko Fujii
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Yasuhiko Nariai
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Yoshiki Sugiura
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Yosuke Kawamura
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Issei Takano
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Yoshihiro Tanaka
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Masaya Nagaishi
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Akio Hyodo
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Kensuke Suzuki
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
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Texakalidis P, Tzoumas A, Xenos D, Rivet DJ, Reavey-Cantwell J. Carotid cavernous fistula (CCF) treatment approaches: A systematic literature review and meta-analysis of transarterial and transvenous embolization for direct and indirect CCFs. Clin Neurol Neurosurg 2021; 204:106601. [PMID: 33774507 DOI: 10.1016/j.clineuro.2021.106601] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/04/2021] [Accepted: 03/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Carotid Cavernous Fistulas (CCFs) are the result of an abnormal communication between the carotid artery and its branches and the venous system of the cavernous sinus. The mainstay of therapy for CCFs consists of transarterial or transvenous embolization, while other treatment options such as open surgery or radiosurgery are still utilized as second-line or adjuvant therapeutic options. OBJECTIVE Our aim was to systematically review and summarize available data regarding short- and long-term outcomes of all available treatment modalities for CCFs. METHODS This systematic review was conducted according to the PRISMA guidelines. A random effects model meta-analysis was conducted. RESULTS Fifty-seven studies comprising 1575 patients were included in this systematic review. Transarterial embolization for direct and indirect CCFs offered a complete obliteration rate of 93.93% (N = 589/627) and 81.51% (N = 119/146), respectively. Transvenous embolization for direct and indirect lesions achieved obliteration in 91.67% (N = 33/36) and 86.03% (N = 425/494) of patients, respectively. Comparison between transarterial and transvenous embolization did not reveal statistically significant differences in terms of fistula obliteration for direct (OR: 1.42; 95% CI: 0.23-8.90; I2 0.0%) and indirect CCFs (OR: 0.62; 95% CI: 0.31-1.23; I2 0.0%). CONCLUSIONS Endovascular embolization techniques are the preferred treatment modality for the management of CCFs. No differences were identified between transarterial and transvenous embolization by synthesizing studies with available data. Future prospective cohorts are warranted to compare the different materials and techniques implemented especially within the rapidly expanding realm of endovascular approaches.
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Affiliation(s)
| | - Andreas Tzoumas
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Xenos
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dennis J Rivet
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA
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Narayanan S, Keshava SN, Moses V, Padmanabhan A, Premkumar P. Ocular Ischemic Syndrome: The Red Eye Revisited. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2020. [DOI: 10.1055/s-0040-1705267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AbstractOcular ischemic syndrome (OIS) is a vision-threatening condition due to inadequate arterial supply to the orbital contents. OIS is commonly described secondary to severe carotid artery stenosis and most often observed by ophthalmologists. However, OIS may rarely also result in an interventional radiology setup during balloon test occlusion (BTO) of the internal carotid artery. BTO is a procedure to assess for the adequacy of the circle of Willis to compensate for a permanent parent arterial sacrifice by temporarily occluding the flow in the internal carotid artery using a balloon. Here, we present a case of OIS in a patient who underwent BOT as a part of presurgical evaluation for the excision of carotid body tumor.
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Affiliation(s)
- Sathya Narayanan
- Department of Interventional Radiology, Division of Clinical Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shyamkumar N. Keshava
- Department of Interventional Radiology, Division of Clinical Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vinu Moses
- Department of Interventional Radiology, Division of Clinical Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aswin Padmanabhan
- Department of Interventional Radiology, Division of Clinical Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prabhu Premkumar
- Department of Vascular Surgery, Christian Medical College, Vellore, Tamil Nadu, India
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Ide S, Kiyosue H, Tokuyama K, Hori Y, Sagara Y, Kubo T. Direct Carotid Cavernous Fistulas. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:583-592. [PMID: 37502141 PMCID: PMC10370662 DOI: 10.5797/jnet.ra.2020-0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/01/2020] [Indexed: 07/29/2023]
Abstract
A direct carotid cavernous fistula (CCF) is an abnormal shunt between the internal carotid artery (ICA) and the cavernous sinus (CS). Traumatic CCF is the most common type, accounting for up to 75% of all CCFs. For the management of direct CCF, endovascular therapy has become the standard. For successful endovascular therapy, evaluation of the size and location of orifice of the CCF, venous drainage, and tolerance for ICA occlusion on cerebral angiography is necessary. Multi-planner reformatted images of 3D rotation angiography are useful to visualize the fistula and compartments of the CS precisely. Due to the limited commercial availability of detachable balloons, detachable coils have become a widely employed endovascular tool for the treatment of direct CCFs. The advantageous aspects of coil application are their easy retrievability and better control. In the case of large/multiple fistulas, adjunctive techniques, including balloon- and stent-assisted techniques, are often needed to occlude the CCF while preserving the ICA. To avoid cranial nerve palsy related to over-packing of the CS with detachable coils or a detachable balloon, selective embolization of the fistula portion is required. Use of liquid embolic materials and covered stents was recently reported as another adjunctive technique. In cases in which it is impossible to occlude the CCF while preserving the ICA, parent artery occlusion (PAO) is considered. The selection of additional/alternative techniques and devices depends on the anatomy and hemodynamics of each CCF, and the skill and experience of individual operators.
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Affiliation(s)
- Satomi Ide
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Hiro Kiyosue
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Kohei Tokuyama
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Yuzo Hori
- Department of Radiology, Nagatomi Neurosurgical Hospital, Oita, Oita, Japan
| | - Yoshiko Sagara
- Department of Radiology, Tsurumi Hospital, Beppu, Oita, Japan
| | - Takeshi Kubo
- Department of Neurosurgery, Oita University Faculty of Medicine, Yufu, Oita, Japan
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Goyal M, van Zwam W, Moret J, Ospel JM. Neurointervention in the 2020s: Where are We Going? Clin Neuroradiol 2020; 31:1-5. [PMID: 32915252 PMCID: PMC7485210 DOI: 10.1007/s00062-020-00953-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/08/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada. .,Department of Radiology, University of Calgary, Calgary, Canada.
| | - Wim van Zwam
- Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht, School for Mental Health and Sciences, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jacques Moret
- The Brain Vascular Center, Baujon University Hospital, Paris, France
| | - Johanna Maria Ospel
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Division of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
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Takahashi K, Nagata Y, Hashikawa T, Sakai H, Matsumoto Y, Nakagawa S, Fukushima Y. Usefulness of Stent-Assisted Coil Embolization of Direct Traumatic Carotid-Cavernous Fistulas: Report of Three Patients and Review of Other Treatment Methods. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:514-521. [PMID: 37501769 PMCID: PMC10370945 DOI: 10.5797/jnet.tn.2020-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 06/12/2020] [Indexed: 07/29/2023]
Abstract
Objective Direct traumatic carotid-cavernous fisulas (dtCCFs) exhibit a high blood flow velocity and are often difficult to be treated. We report three dtCCF cases in which disappearance of the dtCCF and preservation of the internal carotid artery (ICA) were achieved by stent-assisted coil embolization of the fistula. We report these cases and compare them with those previously reported using other treatments. Case Presentations In the first case, we performed coil embolization without stenting for the initial treatment. The cerebral venous reflux disappeared and the patient's symptoms were temporarily ameliorated. However, 5 months after treatment, an aneurysm-like finding around the fistula was noted on MRA. Additional coils and insertion of a neck-bridging stent were required to obliterate the dtCCF and the symptoms disappeared. In the second and third cases, we intended to use stents initially to achieve tight embolization of the fistulas, and obliteration was achieved. Conclusion Use of neck-bridging stenting for dtCCFs may be a reliable method to preserve the parent artery while achieving tight packing around the fistula.
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Affiliation(s)
- Kenji Takahashi
- Department of Neurosurgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | - Yui Nagata
- Department of Neurosurgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | - Takurou Hashikawa
- Department of Neurosurgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | - Hideki Sakai
- Department of Neurosurgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | | | - Setsuko Nakagawa
- Department of Neurosurgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | - Yoshihisa Fukushima
- Division of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Fukuoka, Japan
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Abstract
Interventional neuroradiology (INR) has evolved from a hybrid mixture of daring radiologists and iconoclastic neurosurgeons into a multidisciplinary specialty, which has become indispensable for cerebrovascular and neurological centers worldwide. This manuscript traces the origins of INR and describes its evolution to the present day. The focus will be on cerebrovascular disorders including aneurysms, stroke, brain arteriovenous malformations, dural arteriovenous fistulae, and atherosclerotic disease, both intra- and extracranial. Also discussed are cerebral vasospasm, venolymphatic malformations of the head and neck, tumor embolization, idiopathic intracranial hypertension, inferior petrosal venous sinus sampling for Cushing's disease, and spinal interventions. Pediatric INR has not been included and deserves a separate, dedicated review.
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Oushy S, Rinaldo L, Brinjikji W, Cloft H, Lanzino G. Recent advances in stent-assisted coiling of cerebral aneurysms. Expert Rev Med Devices 2020; 17:519-532. [PMID: 32500761 DOI: 10.1080/17434440.2020.1778463] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Stent-assisted coiling (SAC) of intracranial aneurysms paved the way for endovascular coiling of wide-neck and bifurcation aneurysms, improving rates of aneurysm obliteration and recurrence. In this review, we provide a comprehensive review of the most recent advances related to stent-assisted coiling of intracranial aneurysm. AREAS COVERED The authors have made an attempt to cover the inception, applications, and limitations of SAC of intracranial aneurysms. Special focus is given to 1) the current and recently introduced SAC techniques, 2) most recent advances in device technology, and 3) outcome data for the discussed techniques and devices. The authors also discuss the potential future direction of SAC. EXPERT OPINION technical refinements in the field of SAC should continue to focus on device development and addressing the limitations of SAC, namely aneurysm recurrence and need of antiplatelet agents. Although the recurrence rate of SAC has not been shown to be inferior to flow diverters, the use of intrasaccular and intravascular flow diverters are likely to expand in the future at the expense of SAC.
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Affiliation(s)
- Soliman Oushy
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA
| | - Lorenzo Rinaldo
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA.,Department of Radiology, Mayo Clinic , Rochester, MN, USA
| | - Harry Cloft
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA.,Department of Radiology, Mayo Clinic , Rochester, MN, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA.,Department of Radiology, Mayo Clinic , Rochester, MN, USA
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47
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Kim Y, Hong B, Park H, Youn SK, Sim S, Lim CS, Chung W, Yoon SH. Comparison between Air-Q SP and endotracheal intubation during general anesthesia for endovascular coiling of unruptured cerebral aneurysms. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.05018-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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48
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Kuribara T, Mikami T, Iihoshi S, Miyata K, Kim S, Kawata Y, Komatsu K, Kimura Y, Enatsu R, Akiyama Y, Hirano T, Mikuni N. Ischemic Tolerance Evaluated by Computed Tomography Perfusion during Balloon Test Occlusion. J Stroke Cerebrovasc Dis 2020; 29:104807. [PMID: 32295733 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/21/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Balloon test occlusion (BTO) is performed to evaluate ischemic tolerance for large and giant cerebral aneurysms and head and neck tumors that may require parent artery occlusion. However, ischemic tolerance for the temporary test occlusion does not always guarantee a tolerance for permanent occlusion. In this study, we evaluated the utility of computed tomography (CT) perfusion during BTO to quantify ischemic tolerance for detecting delayed ischemic stroke. MATERIALS AND METHODS Forty-one patients who underwent BTO for the internal carotid artery were included. The correlations between the parameters of CT perfusion and collateral angiographic appearance or stump pressure during BTO were evaluated. The cerebral blood flow (CBF), cerebral blood volume, mean transit time (MTT), and time to peak (TTP) were obtained through CT perfusion, and the asymmetry ratios were determined. Collateral angiographic appearances were categorized into 5 grades (0-4). RESULTS The collateral angiographic appearance showed moderate correlations with CBF, MTT, and TTP that was significant. Of these, the absolute value of the correlation coefficient was the highest for MTT. MTT also showed a moderate correlation with stump pressure. CBF and MTT were significantly different between the poor collateral group (grades 2 and 3) and the good collateral group (grade 4). Based on the MTT, the good collateral group was identified with high sensitivity (75.0%) and specificity (81.2%). CONCLUSIONS In BTO, the MTT obtained through CT perfusion showed a correlation with collateral angiographic appearance and stump pressure. Thus, the MTT might be useful to quantify ischemic tolerance for detecting delayed ischemic stroke.
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Affiliation(s)
| | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
| | - Satoshi Iihoshi
- Department of Endovascular Neurosurgery and Stroke Center, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Kei Miyata
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Sangnyon Kim
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Yuka Kawata
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Katsuya Komatsu
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Yusuke Kimura
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Rei Enatsu
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Yukinori Akiyama
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Toru Hirano
- Division of Radiology, Sapporo Medical University Hospital, Sapporo, Japan
| | - Nobuhiro Mikuni
- Division of Radiology, Sapporo Medical University Hospital, Sapporo, Japan
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Millman B, Giddings NA. Traumatic Carotid-Cavernous Sinus Fistula with Delayed Epistaxis. EAR, NOSE & THROAT JOURNAL 2020. [DOI: 10.1177/014556139407300612] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Brad Millman
- Danville, Pennsylvania
- Department of Otolaryngology/Head and Neck Surgery, Geisinger Medical Center, Danville, PA 17822
| | - Neil A. Giddings
- Danville, Pennsylvania
- Department of Otolaryngology/Head and Neck Surgery, Geisinger Medical Center, Danville, PA 17822
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50
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Chiu AHY, Phillips TJ. Future Directions of Flow Diverter Therapy. Neurosurgery 2020; 86:S106-S116. [PMID: 31838531 PMCID: PMC6911736 DOI: 10.1093/neuros/nyz343] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/26/2019] [Indexed: 12/20/2022] Open
Abstract
The treatment of intracranial aneurysms has undergone a few very significant paradigm shifts in its history. Needless to say, microsurgery and surgical clipping served as the initial basis for successful treatment of these lesions. The pursuit of endovascular therapy subsequently arose from the desire to reduce the invasiveness of therapy. While the first breakthrough arose with Guido Guglielmi's invention of the detachable platinum coil, commercialized flow diverter therapy represents a disruptive therapy with a completely different paradigm for aneurysmal obliteration. This has not only altered the distribution of aneurysmal management strategies, but also opened the gateway to the treatment of previously inoperable lesions. With the basic flow diverter stent technology now considered an integral part of the neurointerventional armamentarium, we now consider what may lay in the future - including potential directions for research with regards to case selection; the location and type of aneurysms which may become routinely treatable; and modifications to the flow diverter, which may increase its utility and safety in terms of size, structural design, and surface modifications.
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Affiliation(s)
- Albert Ho Yuen Chiu
- Neurological Intervention & Imaging Service of Western Australia, Sir Charles Gairdner, Fiona Stanley and Royal Perth Hospitals, WA Health, Perth, Australia
- Division of Medicine, University of Western Australia, Perth, Australia
| | - Timothy John Phillips
- Neurological Intervention & Imaging Service of Western Australia, Sir Charles Gairdner, Fiona Stanley and Royal Perth Hospitals, WA Health, Perth, Australia
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