212 research outputs found
LB-009 Retreatment of residual and recurrent aneurysms following embolization with the woven endobridge (WEB) device: multicenter case series
No full textObjectiveThe Woven EndoBridge (WEB) device was approved by the U.S. Food and Drug Administration (FDA) as the first intrasaccular device for intracranial aneurysm treatment in December 2018. Its use has become more common since then, but both trial results and post-market experiences have raised questions about efficacy in achieving complete aneurysm obliteration. Retreatment after WEB embolization has not been extensively discussed.MethodsRetrospective review across 13 institutions identified all occurrences of WEB retreatment within neurovascular databases. Details regarding demographics, aneurysm characteristics, treatment considerations, clinical outcomes, and aneurysm occlusion were obtained and analyzed.ResultsTwenty-nine aneurysms were retreated in 29 patients. Endovascular methods were used for 22 cases and 7 were treated surgically. Endovascular treatments included stent-assisted coiling (12), flow diversion (6), coiling (2), PulseRider-assisted coiling (1), and additional WEB placement (1). Surgical treatments included primary clipping (6) and Hunterian ligation (1). There were no major complications within the study group.Abstract LB-009 Figure 1Abstract LB-009 Figure 2Abstract LB-009 Figure 3ConclusionsWEB retreatments were successfully performed by a variety of techniques, including stent-assisted coiling, clipping, and flow diversion as the most common. These procedures were performed safely with subsequent obliteration of most aneurysms. The potential need for retreatment of aneurysms should be considered during primary WEB treatments.DisclosuresV. Srinivasan: None. A. Dmytriw: None. R. Regenhardt: None. J. Vicenty-Padilla: None. M. Aziz-Sultan: None. A. Patel: None. N. Alotaibi: None. E. Levy: None. M. Waqas: None. J. Cherian: None. J. Johnson: None. P. Jabbour: None. A. Sweid: None. B. Gross: None. R. Starke: None. A. Puri: None. F. Massari: None. C. Griessenauer: None. J. Catapano: None. C. Rutledge: None. O. Tanweer: None. P. Yashar: None. G. Cortez: None. R. Hanel: None. A. Ducruet: None. F. Albuquerque: None. M. Lawton: None. P. Kan: None
The Superficial Anastomosing Veins of the Human Brain Cortex: A Microneurosurgical Anatomical Study
No full textIntroduction: In this microneurosurgical and anatomical study, we characterized the superficial anastomosing veins of the human brain cortex in human specimens. Material and Methods: We used 21 brain preparations fixed in formalin (5%) that showed no pathological changes and came from the autopsy sections. The superficial veins were dissected out of the arachnoid with the aid of a surgical microscope. Results: We dissected nine female and 12 male brain specimens, with an average age of 71 ± 11 years (range 51–88 years). We classified the superficial veins in five types: (I) the vein of Trolard as the dominat vein; (II) the vein of Labbé as the dominant vein; (III) a dominant sylvian vein group, and the veins of Trolard and Labbé nonexistent or only rudimentary present without contact to the Sylvian vein group; (IV) very weak sylvian veins with the veins of Trolard and Labbé codominant; and V) direct connection of Trolard and Labbé bypassing the Sylvian vein group. The vein of Trolard was dominant (Type I) in 21.4% and the vein of Labbé (Type II) in 16.7%. A dominant sylvian vein group (Type III) was found in 42.9%. Type IV and Type V were found in 14.3 and 4.7% respectively. Conclusion: No systematic description or numerical distribution of the superior anastomotic vein (V. Trolard) and inferior anastomotic vein (V. Labbé) has been found in the existing literature. This study aimed to fill this gap in current literature and provide data to neurosurgeons for the practical planning of surgical approaches
E-133 Timing of microsurgical intervention for ruptured arteriovenous malformations: a multicenter study
No full textBackgroundBrain arteriovenous malformations (bAVMs) are rare but critical vascular anomalies that can rupture and lead to significant morbidity and mortality. The timing of microsurgical treatment (MST) for ruptured bAVMs is controversial, with conflicting evidence on whether early or delayed intervention leads to better outcomes. This multicenter study investigates the impact of MST timing on outcomes following bAVM rupture.MethodsWe conducted a retrospective analysis using data from the Multicenter International Study for Treatment of Brain AVMs (MISTA), including 237 patients treated for ruptured bAVMs. Patients were divided into three groups based on the timing of MST: within or after 24 hours, within or after 7 days, and within or after 14 days. Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics, and statistical analyses were performed to compare mortality, functional outcomes (mRS 0–2), and complication rates across the different time intervals.ResultsDelaying MST beyond 7 days significantly reduced mortality (OR: 0.08, 95% CI: 0.01–0.67, P = 0.03) and improved functional outcomes (OR: 1.54, 95% CI: 1.03–2.30, P = 0.04) compared to earlier intervention. After 14 days, mortality remained significantly lower (OR: 0.10, 95% CI: 0.01–0.77, P = 0.03), but no additional improvement in functional outcomes was observed. Complete obliteration rates and complication rates showed no significant differences across groups. Our subgroup analysis comparing MST with preoperative embolization and MST showed that MST was associated with a significantly lower mortality odds after 7 and 14 days (P-interaction <0.001).ConclusionsOur findings suggest that delaying MST for ruptured bAVMs to between 7 and 14 days may provide an optimal balance between reducing mortality and achieving favorable functional outcomes. Also, MST alone achieved lower mortality and complications odds compared to preoperative embolization with MST. Further large-scale prospective studies are needed.DisclosuresB. Musmar: None. N. Adeeb: None. H. Salim: None. J. Roy: None. A. Aslan: None. S. Tjoumakaris: None. C. Ogilvy: None. M. Baskaya: None. D. Kondziolka: None. J. Sheehan: None. H. Riina: None. S. Kandregula: None. A. Dmytriw: None. N. Ironside: None. G. Mantziaris: None. M. Park: None. J. Pöppe: None. R. Sen: None. C. Griessenauer: None. J. Burkhardt: None. R. Starke: None. L. Sekhar: None. M. Levitt: None. D. Altschul: None. N. Haranhalli: None. M. McAvoy: None. A. Abla: None. M. Gooch: None. R. Rosenwasser: None. C. Stapleton: None. M. Koch: None. V. Srinivasan: None. B. Guthikonda: None. J. Morcos: None. P. Jabbour: None
E-203 Arteriovenous malformations with single versus multiple draining veins: a multicenter study
No full textIntroductionCerebral arteriovenous malformations (AVMs) are complex vascular lesions that pose a risk for hemorrhagic stroke. The number of draining veins has recently emerged as a significant predictor of rupture risk. This multicenter study aimed to evaluate the outcomes in adult AVM patients with single versus multiple draining veins.MethodsWe conducted a retrospective analysis of 735 AVM patients from the Multicenter International Study for Treatment of Brain AVMs (MISTA) database. Patients were categorized into single draining vein (n=430) and multiple draining veins (n=305) groups. Logistic and linear regression models were used to assess outcomes, adjusting for baseline characteristics, including age, rupture status, Spetzler-Martin grade, and other relevant factors.ResultsAfter adjustment, no significant differences were observed in complete AVM obliteration at last follow-up between the multiple and single draining veins groups (OR: 1.1; 95% CI: 0.72–1.93, p=0.49) after any treatment type. Good functional outcomes at last follow-up (mRS 0–2) were similar between the two groups (OR: 1.00; 95% CI: 0.48–2.09, p=0.98), as were retreatment rates (OR: 1.68; 95% CI: 0.74–3.83, p=0.21). Ruptured AVMs were more common in the single draining vein group (52.0% vs. 35.4%, p< 0.001). Patients in the multiple draining vein group had lower odds of hemorrhagic complications compared to the single vein group (OR: 0.38; 95% CI: 0.14–1.02, p=0.05).ConclusionSingle draining vein AVMs were more likely to present with rupture, but no significant differences in obliteration rates, functional outcomes, or retreatment rates were found between the groups after adjustment. These findings suggest that while venous drainage patterns may influence initial presentation, they do not appear to affect overall treatment success or patient prognosis after any treatment type. Further studies are needed to confirm.DisclosuresB. Musmar: None. N. Adeeb: None. H. Abdalrazeq: None. H. Salim: None. J. Roy: None. A. Aslan: None. S. Tjoumakaris: None. C. Ogilvy: None. M. Baskaya: None. D. Kondziolka: None. J. Sheehan: None. H. Riina: None. S. Kandregula: None. A. Dmytriw: None. N. Ironside: None. G. Mantziaris: None. M. Park: None. J. Pöppe: None. R. Sen: None. C. Griessenauer: None. J. Burkhardt: None. R. Starke: None. L. Sekhar: None. M. Levitt: None. D. Altschul: None. N. Haranhalli: None. M. McAvoy: None. A. Abla: None. M. Gooch: None. R. Rosenwasser: None. C. Stapleton: None. M. Koch: None. V. Srinivasan: None. B. Guthikonda: None. J. Morcos: None. P. Jabbour: None
The Superficial Anastomosing Veins of the Human Brain Cortex: A Microneurosurgical Anatomical Study
No full textIn this microneurosurgical and anatomical study, we characterized the superficial anastomosing veins of the human brain cortex in human specimens. We used 21 brain preparations fixed in formalin (5%) that showed no pathological changes and came from the autopsy sections. The superficial veins were dissected out of the arachnoid with the aid of a surgical microscope. We dissected nine female and 12 male brain specimens, with an average age of 71 ± 11 years (range 51-88 years). We classified the superficial veins in five types: (I) the vein of Trolard as the dominat vein; (II) the vein of Labbé as the dominant vein; (III) a dominant sylvian vein group, and the veins of Trolard and Labbé nonexistent or only rudimentary present without contact to the Sylvian vein group; (IV) very weak sylvian veins with the veins of Trolard and Labbé codominant; and V) direct connection of Trolard and Labbé bypassing the Sylvian vein group. The vein of Trolard was dominant (Type I) in 21.4% and the vein of Labbé (Type II) in 16.7%. A dominant sylvian vein group (Type III) was found in 42.9%. Type IV and Type V were found in 14.3 and 4.7% respectively. No systematic description or numerical distribution of the superior anastomotic vein (V. Trolard) and inferior anastomotic vein (V. Labbé) has been found in the existing literature. This study aimed to fill this gap in current literature and provide data to neurosurgeons for the practical planning of surgical approaches
Outlaw Motorcycle Gangs: Aspects of the One-Percenter Culture for Emergency Department Personnel to Consider
No full textOutlaw motorcycle gangs (OMGs) are an iconic element of the criminal landscape in the United States, the country of their origin. Members of OMGs may present to the emergency department (ED) as a result of motor vehicle accidents or interpersonal violence. When one member of an OMG is injured, other members and associates are likely to arrive in the ED to support the injured member. The extant literature for ED personnel lacks an overview of the culture of OMGs, a culture that promotes the display of unique symbols and that holds certain paraphernalia as integral to an outlaw biker’s identity and pride. The objective of this manuscript is to discuss various aspects of the culture of OMGs so that ED personnel may better understand the mentality of the outlaw biker. Knowledge of their symbols, values, and hierarchy can be crucial to maintaining order in the ED when an injured outlaw biker presents to the ED. We used standard search engines to obtain reports from law enforcement agencies and studies in academic journals on OMGs. We present the observations of 1 author who has conducted ethnographic research on outlaw bikers since the 1980s
A genome-wide association study of outcome after aneurysmal subarachnoid haemorrhage: discovery analysis
No full textCandidate gene studies have identified genetic variants associated with clinical outcomes following aneurysmal subarachnoid haemorrhage (aSAH), but no genome-wide association studies have been performed to date. Here we report the results of the discovery phase of a two-stage genome-wide meta-analysis of outcome after aSAH. We identified 157 independent loci harbouring 756 genetic variants associated with outcome after aSAH (p < 1 × 10
−4), which require validation. A single variant (rs12949158), in SPNS2, achieved genome-wide significance (p = 4.29 × 10
−8) implicating sphingosine-1-phosphate signalling in outcome after aSAH. A large multicentre international effort to recruit samples for validation is required and ongoing. Validation of these findings will provide significant insight into the pathophysiology of outcomes after aSAH with potential implications for treatment.
</p
Genome-wide association study of clinical outcome after aneurysmal subarachnoid haemorrhage: protocol
No full textAneurysmal subarachnoid haemorrhage (aSAH) results in persistent clinical deficits which prevent survivors from returning to normal daily functioning. Only a small fraction of the variation in clinical outcome following aSAH is explained by known clinical, demographic and imaging variables; meaning additional unknown factors must play a key role in clinical outcome. There is a growing body of evidence that genetic variation is important in determining outcome following aSAH. Understanding genetic determinants of outcome will help to improve prognostic modelling, stratify patients in clinical trials and target novel strategies to treat this devastating disease. This protocol details a two-stage genome-wide association study to identify susceptibility loci for clinical outcome after aSAH using individual patient-level data from multiple international cohorts. Clinical outcome will be assessed using the modified Rankin Scale or Glasgow Outcome Scale at 1–24 months. The stage 1 discovery will involve meta-analysis of individual-level genotypes from different cohorts, controlling for key covariates. Based on statistical significance, supplemented by biological relevance, top single nucleotide polymorphisms will be selected for replication at stage 2. The study has national and local ethical approval. The results of this study will be rapidly communicated to clinicians, researchers and patients through open-access publication(s), presentation(s) at international conferences and via our patient and public network
A balancing act: D4 receptor activation and the neurobiological basis of emotional learning
No full textA balancing act: D4 receptor activation and the neurobiological basis of emotional learnin
Successful endoluminal reconstruction of a pseudoaneurysm of the internal carotid artery following a transorbital stab injury
No full textTraumatic penetrating injuries to the internal carotid artery (ICA) resulting in the formation of a traumatic pseudoaneurysm are potentially devastating injuries. Previously treatment included, open surgical occlusion of the affected vessel or endovascular embolization. However, with the advent of flow diverter stents, endoluminal reconstruction has become a viable treatment option. In this case report we describe the successful managment of an ICA pseudoaneurysm due to a transorbital stab injury. Endoluminal reconstruction in a traumatic aneurysm is a feasible option. Considering the risk of hemorrhagic complications due to dual antiplatelet therapy required after flow diverter placement, this treatment should only be chosen if insufficient collateral supply is found and occlusion of the affected vessel is not a viable option. © 202
- …
