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Preoperative Embolization of Extra-axial Hypervascular Tumors with Onyx
Matthew R. Fusco,Bradley A. Gross,Mohamed M. Salem,Arra S. Reddy,Christopher S. Ogilvy,Ekkehard M. Kasper,Ajith J. Thomas 대한뇌혈관외과학회 2016 Journal of Cerebrovascular and Endovascular Neuros Vol.18 No.1
Objective:Preoperative endovascular embolization of intracranial tumors is performed to mitigate anticipated intraoperative blood loss. Although the usage of a wide array of embolic agents, particularly polyvinyl alcohol (PVA), has been described for a variety of tumors, literature detailing the efficacy, safety and complication rates for the usage of Onyx is relatively sparse. Materials and Methods:We reviewed our single institutional experience with pre-surgical Onyx embolization of extra-axial tumors to evaluate its efficacy and safety and highlight nuances of individualized cases. Results:Five patients underwent pre-surgical Onyx embolization of large or giant extra-axial tumors within 24 hours of surgical resection. Four patients harbored falcine or convexity meningiomas (grade I in 2 patients, grade II in 1 patient and grade III in one patient), and one patient had a grade II hemangiopericytoma. Embolization proceeded uneventfully in all cases and there were no complications. Conclusion:This series augments the expanding literature confirming the safety and efficacy of Onyx in the preoperative embolization of extra-axial tumors, underscoring its advantage of being able to attain extensive devascularization via only one supplying pedicle.
Middle Meningeal Artery Arising from the Basilar Artery
Mohamed M. Salem,Matthew R. Fusco,Parviz Dolati,Arra S. Reddy,Bradley A. Gross,Christopher S. Ogilvy,Ajith J. Thomas 대한뇌혈관외과학회 2014 Journal of Cerebrovascular and Endovascular Neuros Vol.16 No.4
Various anomalies for the origin of the middle meningeal artery (MMA)have been described in the literature. However, origin of the MMA fromthe basilar trunk is an extremely rare variant. We report on a 54-year-oldfemale who presented with frequent headaches; magnetic resonanceimaging showed a right parietal meningioma. The abnormal origin of themiddle meningeal artery from the basilar artery was diagnosed by angiographyperformed for preoperative embolization of the tumor. We reporton the case with a review of the embryologic basis, possible explanationsfor this aberrant origin, and its clinical implications.
Michelle H. Chua,Ajith J. Thomas,Matthew R. Fusco,Christopher S. Ogilvy 대한뇌혈관외과학회 2014 Journal of Cerebrovascular and Endovascular Neuros Vol.16 No.4
Variations of the anterior cerebral artery-anterior communicating arterycomplex are commonly identified in aneurysm surgery. An infraopticcourse of the anterior cerebral artery is exceedingly rare. Robison first describedthis anomaly from an anatomic dissection in 1959. A unilateralanomalous infraoptic anterior cerebral artery is more common than anomaliesof bilateral infraoptic anterior cerebral arteries. We present the case of anunruptured aneurysm at the anterior communicating artery in a patientwith bilateral infraoptic anterior cerebral arteries, identified by computedtomography angiography and verified during surgery. Implications foraneurysm formation and surgical treatment are discussed.
Intra-arterial Onyx Embolization of Vertebral Body Lesions
Neda I. Sedora-Roman,Bradley A. Gross,Arra Suresh Reddy,Christopher S. Ogilvy,Ajith J. Thomas 대한뇌혈관외과학회 2013 Journal of Cerebrovascular and Endovascular Neuros Vol.15 No.4
While Onyx embolization of cerebrospinal arteriovenous shunts is well-established,clinical researchers continue to broaden applications to other vascular lesions of the neuraxis. This report illustrates the application of Onyx (eV3, Plymouth, MN) embolization to vertebral body lesions, specifically,a vertebral hemangioma and renal cell carcinoma vertebral body metastatic lesion.
Shooka Esmaeeli,Courtney M. Hrdlicka,Andres Brenes Bastos,Jeffrey Wang,Santiago Gomez-Paz,Khalid A. Hanafy,Vasileios-Arsenios Lioutas,Christopher S. Ogilvy,Ajith J. Thomas,Shahzad Shaefi,Corey R. Fehn 대한신경집중치료학회 2020 대한신경집중치료학회지 Vol.13 No.1
Background: Transcranial Doppler (TCD) ultrasound is an essential tool for the detection of cerebral vasospasm after subarachnoid hemorrhage (SAH) but is limited by the availability of skilled operators. We examined the clinical feasibility and concordance of a robotically assisted TCD system with artificial intelligence with routine handheld TCD after SAH. Methods: We evaluated TCD velocities in the anterior cerebral artery (ACA) and middle cerebral artery (MCA) of two patients with high-grade SAH and angiographic evidence of vasospasm. A single channel TCD device with a handheld diagnostic probe as well as a robotically assisted TCD device was used, the relationship of the two tests was evaluated using the bootstrap method of resampling for the concordance correlation coefficient (CCC) paired with a Pearson’s correlation analysis, followed by a Bland-Altman plot. Results: Patient 1 developed angiographic and TCD evidence of vasospasm in the proximal right MCA, but except for periods of disorientation remained neurologically intact. Angiographic, TCD and clinical evidence of ACA spasm occurred 6 days after ictus in patient 2. Robotically measured mean flow velocities were comparable to manual TCDs in the MCAs (CCC=0.83; 95% confidence interval [CI], 0.42 to 0.96; P=0.001) but not in the ACAs (CCC=0.26; 95% CI, –0.01 to 0.71; P=0.26). Conclusion: Robotically assisted TCD system with artificial intelligence provides an alternative to manual TCD for assessment of MCA velocities in patients with SAH, expanding the availability of TCD to settings in which specialized clinicians are not available. Further studies for validation of this technology are warranted.
Justin C. Gelman,Max Shutran,Michael Young,Philipp Taussky,Rafael A. Vega,Rocco Armonda,Christopher S. Ogilvy 대한뇌혈관외과학회 2023 Journal of Cerebrovascular and Endovascular Neuros Vol.25 No.4
Pseudoaneurysms are rare but devastating complications of penetrating head traumas. They require rapid surgical or endovascular intervention due to their high risk of rupture; however, complex presentations may limit treatment options. Our objective is to report a case of severe vasospasm, flow diversion, and in-stent stenosis complicating the treatment of a middle cerebral artery pseudoaneurysm following a gunshot wound. A 33-year-old woman presented with multiple calvarial and bullet fragments within the right frontotemporal lobes and a large right frontotemporal intraparenchymal hemorrhage with significant cerebral edema. She underwent an emergent right hemicraniectomy for decompression, removal of bullet fragments, and evacuation of hemorrhage. Once stable enough for diagnostic cerebral angiography, she was found to have an M1 pseudoaneurysm with severe vasospasm that precluded endovascular treatment until the vasospasm resolved. The pseudoaneurysm was treated with flow diversion and in-stent stenosis was found at 4-month follow-up angiography that resolved by 8 months post-embolization. We report the successful flow diversion of an middle cerebral artery (MCA) pseudoaneurysm complicated by severe vasospasm and later in-stent stenosis. The presence of asymptomatic stenosis is believed to be reversible intimal hyperplasia and a normal aspect of endothelial healing. We suggest careful observation and dual-antiplatelet therapy as a justified approach.