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  • 1
    Online Resource
    Online Resource
    Comparison of Endovascular and Surface Cooling during Unruptured Cerebral Aneurysm Repair
    Ovid Technologies (Wolters Kluwer Health) ; 2004
    In:  Neurosurgery Vol. 55, No. 2 ( 2004-08-01), p. 307-315
    Details
    In: Neurosurgery, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. 2 ( 2004-08-01), p. 307-315
    Abstract: To compare endovascular versus surface methods for the induction and reversal of hypothermia during neurosurgery in a multicenter, prospective, randomized study. METHODS: Patients undergoing elective open craniotomy for repair of an unruptured cerebral aneurysm (n = 153) were randomly assigned (2:1) to undergo whole-body hypothermia to 33°C, either with an endovascular cooling device placed in the inferior vena cava via the femoral vein (n = 92) or with a surface convective air blanket (n = 61). Active rewarming was accomplished using the same devices. RESULTS: Cooling rates in endovascular and surface blanket groups averaged 4.77 and 0.87°C/h, respectively (P & lt; 0.001). When the first temporary arterial or aneurysm clip was placed, 99% of endovascular patients and 20% of surface blanket patients had reached the target of 33°C (P & lt; 0.001). Obese patients were cooled efficiently with the endovascular approach (3.56°C/h). Rewarming rates averaged 1.88°C/h for endovascular patients and 0.69°C/h for surface blanket patients (P & lt; 0.001). By the end of surgery, 89 and 53% of these patients, respectively, had rewarmed to at least 35°C (P & lt; 0.001). On leaving the operating room, 14% of endovascular patients and 28% of surface blanket patients were still intubated (P = 0.035). The overall safety of the two procedures was comparable. No clinically significant catheter-related thrombotic, bleeding, or infectious complications were reported in the endovascular group. CONCLUSION: Endovascular cooling provided superior induction, maintenance, and reversal of hypothermia compared with the surface blanket, without an increase in complications. Endovascular cooling may have clinical benefit for patients undergoing cerebrovascular surgery, as well as patients with acute stroke, head injury, or acute myocardial infarction.
    Type of Medium: Online Resource
    ISSN: 1524-4040 , 0148-396X
    URL: Article
    DOI: 10.1227/01.NEU.0000129683.99430.8C
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2004
    detail.hit.zdb_id: 1491894-8
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  • 2
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    Progression of Unilateral Moyamoya Disease: A Clinical Series
    S. Karger AG ; 2006
    In:  Cerebrovascular Diseases Vol. 22, No. 2-3 ( 2006), p. 109-115
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 22, No. 2-3 ( 2006), p. 109-115
    Abstract: 〈 i 〉 Background: 〈 /i 〉 The natural history of unilateral moyamoya disease (MMD) in adult patients is not clearly described in the literature. We present a series of 18 patients with unilateral MMD and analyze the risk factors for progression to bilateral disease. 〈 i 〉 Methods: 〈 /i 〉 A retrospective review of 157 MMD patients treated at Stanford University Medical Center from 1991 to 2005 identified 28 patients with unilateral MMD (defined as none, equivocal or mild involvement on the contralateral side). 〈 i 〉 Results: 〈 /i 〉 Eigh teen patients (5 males and 13 females) were identified with unilateral MMD and angiographic follow-up of ≧5 months. Mean radiologic follow-up (± standard error of the mean) was 19.3 ± 3.4 months and mean clinical follow-up was 24.5 ± 3.7 months. Five patients had childhood onset MMD and 13 patients had adult onset disease. Angiographic progression from unilateral to bilateral disease was seen in 7 patients (38.9%) at a mean follow-up of 12.7 ± 2.4 months. Four of the 7 patients had significant clinical and radiologic progression requiring surgical intervention. Five of 7 patients that progressed had adult onset MMD. The presence of equivocal or mild stenotic changes of the contralateral anterior cerebral artery (ACA), middle cerebral artery (MCA) or internal carotid artery (ICA) was an important predictor of progression (p 〈 0.01); 6 of 8 patients (75%) with equivocal or mild contralateral disease progressed, whereas only 1 of 10 patients (10.0%) with no initial contralateral disease progressed to bilateral MMD. One patient had mild or equivocal MCA, ICA and ACA stenosis at the time of initial diagnosis and this patient progressed. 〈 i 〉 Conclusions: 〈 /i 〉 Contralateral progression in the adult form occurs more commonly than previously reported. The presence of minor changes in the contralateral ACA, intracranial ICA and MCA is an important predictor of increased risk of progression. Patients with a completely normal angiogram on the contralateral side have a very low risk of progression.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000093238
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2006
    detail.hit.zdb_id: 1482069-9
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  • 3
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    Multimodality treatment of posterior fossa arteriovenous malformations
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2008
    In:  Journal of Neurosurgery Vol. 108, No. 6 ( 2008-06), p. 1152-1161
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 108, No. 6 ( 2008-06), p. 1152-1161
    Abstract: Posterior fossa arteriovenous malformations (AVMs) are relatively uncommon and often difficult to treat. The authors present their experience with multimodality treatment of 76 posterior fossa AVMs, with an emphasis on Spetzler–Martin Grades III–V AVMs. Methods Seventy-six patients with posterior fossa AVMs treated with radiosurgery, surgery, and endovascular techniques were analyzed. Results Between 1982 and 2006, 36 patients with cerebellar AVMs, 33 with brainstem AVMs, and 7 with combined cerebellar–brainstem AVMs were treated. Natural history data were calculated for all 76 patients. The risk of hemorrhage from presentation until initial treatment was 8.4% per year, and it was 9.6% per year after treatment and before obliteration. Forty-eight patients had Grades III–V AVMs with a mean follow-up of 4.8 years (range 0.1–18.4 years, median 3.1 years). Fifty-two percent of patients with Grades III–V AVMs had complete obliteration at the last follow-up visit. Three (21.4%) of 14 patients were cured with a single radiosurgery treatment, and 4 (28.6%) of 14 with 1 or 2 radiosurgery treatments. Twenty-one (61.8%) of 34 patients were cured with multimodality treatment. The mean Glasgow Outcome Scale (GOS) score after treatment was 3.8. Multivariate analysis performed in the 48 patients with Grades III–V AVMs showed radiosurgery alone to be a negative predictor of cure (p = 0.0047). Radiosurgery treatment alone was not a positive predictor of excellent clinical outcome (GOS Score 5; p 〉 0.05). Nine (18.8%) of 48 patients had major neurological complications related to treatment. Conclusions Single-treatment radiosurgery has a low cure rate for posterior fossa Spetzler–Martin Grades III–V AVMs. Multimodality therapy nearly tripled this cure rate, with an acceptable risk of complications and excellent or good clinical outcomes in 81% of patients. Radiosurgery alone should be used for intrinsic brainstem AVMs, and multimodality treatment should be considered for all other posterior fossa AVMs.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/JNS/2008/108/6/1152
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2008
    detail.hit.zdb_id: 2026156-1
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  • 4
    Online Resource
    Online Resource
    Visual Field Preservation After Curative Multi-Modality Treatment of Occipital Lobe Arteriovenous Malformations
    Ovid Technologies (Wolters Kluwer Health) ; 2005
    In:  Neurosurgery Vol. 57, No. 4 ( 2005-10), p. 655-667
    Details
    In: Neurosurgery, Ovid Technologies (Wolters Kluwer Health), Vol. 57, No. 4 ( 2005-10), p. 655-667
    Type of Medium: Online Resource
    ISSN: 0148-396X , 1524-4040
    URL: Article
    DOI: 10.1093/neurosurgery/57.4.655
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2005
    detail.hit.zdb_id: 1491894-8
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  • 5
    Online Resource
    Online Resource
    Visual Field Preservation After Curative Multi-Modality Treatment of Occipital Lobe Arteriovenous Malformations
    Ovid Technologies (Wolters Kluwer Health) ; 2005
    In:  Neurosurgery Vol. 57, No. 4 ( 2005-10), p. 655-667
    Details
    In: Neurosurgery, Ovid Technologies (Wolters Kluwer Health), Vol. 57, No. 4 ( 2005-10), p. 655-667
    Type of Medium: Online Resource
    ISSN: 0148-396X
    URL: Article
    DOI: 10.1227/01.NEU.0000175547.05291.85
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2005
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  • 6
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    Short- and long-term outcomes of moyamoya patients post-revascularization
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2022
    In:  Journal of Neurosurgery ( 2022-10-01), p. 1-11
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), ( 2022-10-01), p. 1-11
    Abstract: The post-bypass stroke risk factors and long-term outcomes of moyamoya patients are not well documented. Therefore, the authors studied 30-day stroke risks and patients’ long-term physical, functional, and social well-being. METHODS This was a single-institution combined moyamoya disease (MMD) database interrogation and questionnaire study. From 1991 to 2014, 1250 revascularization procedures (1118 direct bypasses, 132 indirect bypasses) were performed in 769 patients. Completed questionnaires were received from and available for analysis on 391 patients, and 6-month follow-up data were available for 96.4% (741/769) of the patients. RESULTS The patients consisted of 548 females and 221 males, with a mean age of 32 years (range 1–69 years). Three hundred fifty-eight bypasses were performed in 205 pediatric patients (73% direct bypasses), and 892 revascularizations were performed in 564 adults (96% direct bypasses). Fifty-two patients (6.8%) developed major strokes with a worsening modified Rankin Scale (mRS) score within 30 days postoperatively. The 30-day major stroke risk was 5.3% (41/769) and 2.6% (12/467) after the first and second bypasses, respectively. Logistic regression analysis revealed that older age, modified MRI (mMRI) score, and hemodynamic reserve (HDR) score are clearly associated with higher postoperative stroke risks. Over a mean follow-up of 7.3 years (range 0.5–26 years), the long-term stroke risk among 741 patients was 0.6% per patient-year; 75% of these patients had excellent outcomes (mRS score 0–1). The long-term outcome questionnaire study showed that 84% (234/277) of patients reported resolution or improvement in their preoperative headache, 83% (325/391) remained employed or in school, and 87% (303/348) were self-caring. CONCLUSIONS In this large, single-center surgical series, most of the adult and pediatric patients had direct revascularization, with a 4.2% per-bypass-procedure (6.8% per patient) 30-day major stroke risk and a 0.6% per-patient-year long-term stroke risk. The authors identified various risk factors that are highly correlated with postoperative morbidity (age, mMRI score, and HDR score) and are involved in ongoing work to develop the predictive modeling for future patient selection and treatment.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2022.8.JNS22336
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2022
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  • 7
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    Online Resource
    Abstract NS10: Development of a Comprehensive Stroke Center Electronic Medical Records Navigator: Experience in one Academic Stroke Center
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Electronic medical records (EMR) have become the standard of care for documentation in today’s health care settings. The EMR system allows for standardization of care and widespread access to information with ability to subsequently evaluate that care. Additionally, trends are more easily documented and monitored. Development of a stroke specific EMR system for a comprehensive stroke center (CSC) was the goal from the initiation of our multidisciplinary steering committee. Our center enlisted the stroke nursing and physician teams, administration, health services researcher, quality and clinical informatics teams to develop an EMR navigator tool based on guidelines from the American Heart/Stroke Association (AHA/ASA) in anticipation of being an early CSC. It was designed to be used for all patients with a diagnosis of stroke during hospitalization. The informatics team developed a method to capture proposed CSC metrics and quality indicators. Progress notes were developed to auto populate necessary data using a specific template. Order sets were standardized according to AHA/ASA guidelines. Discrete fields were built into the EMR to ensure data could be automatically aggregated to evaluate quality-of-care for all stroke patients without requiring chart review. Efforts were made to ensure ease of use and efficiency while preventing errors. The navigators were designed to allow for reports required by Joint Commission to be more readily run on a regular and ongoing basis. Clinical informatics worked with representatives from EPIC to develop custom code for unique situations such as “door to needle time,” as required by Joint Commission. Smart phrases were identified when able, but minimized to prevent duplicity and erroneous assessment and documentation. Stroke patients often require complex interdisciplinary team care. Having a stroke navigator EMR in place enables all health care providers to have consistent access to information at hand to improve our ability to provide comprehensive care. Cues for care can be provided, improving safety and preventing errors. It also enables standardization of data extraction with ability to track progress between notes and trend data in spread sheet format.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.ANS10
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
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  • 8
    Online Resource
    Online Resource
    Neurocognitive Performance After Cerebral Revascularization in Adult Moyamoya Disease
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 6 ( 2017-06), p. 1514-1517
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 6 ( 2017-06), p. 1514-1517
    Abstract: Cerebral revascularization using EC-IC bypass is widely used to treat moyamoya disease, but the effects of surgery on cognition are unknown. We compared performance on formal neurocognitive testing in adults with moyamoya disease before and after undergoing direct EC-IC bypass. Methods— We performed a structured battery of 13 neurocognitive tests on 84 adults with moyamoya disease before and 6 months after EC-IC bypass. The results were analyzed using reliable change indices for each test, to minimize test–retest variability and practice effects. Results— Twelve patients (14%) showed significant decline postoperatively, 9 patients (11%) improved, and 63 patients (75%) were unchanged. Similar results were obtained when the analysis was confined to those who underwent unilateral (33) or bilateral (51) revascularization. Conclusions— The majority of patients showed neither significant decline nor improvement in neurocognitive performance after EC-IC bypass surgery. Uncomplicated EC-IC bypass seems not to be a risk factor for cognitive decline in this patient population.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.116.016028
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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  • 9
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    Online Resource
    Abstract WP282: Moyamoya Disease and Pregnancy: A Single Institutional Experience in the USA
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. Suppl_1 ( 2018-01-22)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Abstract: Introduction: Moyamoya disease is a progressive bilateral steno-occlusive disease of the terminal internal carotid arteries accompanied by development of collateral moyamoya vessels. It affects a younger population and thus, women in their reproductive years. We aim to define the practices, comorbidities and outcomes of pregnancies in women with moyamoya disease. Method: We conducted a retrospective review of 33 patients and 49 successful pregnancies between 1992 and 2017 at Stanford Health Care/Lucile Packard Children’s Hospital from our institutional database by surveys and chart review. Results: To date we have completed 1483 revascularization procedures in 930 patients. Out of these 930 patients we identified 45 patients who had pregnancies immediately prior to the diagnosis of moyamoya disease and some after being diagnosed with moyamoya. 33 out of these 45 patients’ charts and consents were available for review. These 33 patients had 49 successful pregnancies. There were 20 single pregnancies, 10 women had 2 pregnancies each and 3 woman had 3 successful pregnancies. 22 pregnancies were NVD (normal vaginal deliveries), 2 were assisted vaginal and 25 were C-sections. Maternal age varied from 19 years to 40 years. Gestational age ranged between 32 weeks to 40 weeks. 8/49(16.3%) pregnancies were associated with transient ischemic attacks or stroke. 44 pregnancies had a history of revascularization before or during pregnancy, and 5 pregnancies occurred prior to any revascularization. 8/49(16.3%) pregnancies were associated with eclampcia and pre-eclampcia and 9/49(18%) with hypertension. Neonatal complications included low birth weight 2/49 (4%), Mild jaundice 2/49 (4%), Tachypnea 1/49 (2%), Acid reflux 1/49 (2%), NICU stay 3/49 (6%). Conclusion: Our study shows that the trend in the USA is towards vaginal delivery in patients with moyamoya disease: 51.1%, is less than whein compared with studies in Asia. We also show that both the patients and babies do well. The complication rate is minimal, including no strokes in the peripartum period in patients who have been treated. We would advocate vaginal deliveries in the absence of any other contraindications along with peripartum blood pressure control.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.WP282
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 10
    Online Resource
    Online Resource
    Neurocognitive Impairment in Adults With Moyamoya Disease Without Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Neurosurgery Vol. 70, No. 3 ( 2012-03), p. 634-638
    Details
    In: Neurosurgery, Ovid Technologies (Wolters Kluwer Health), Vol. 70, No. 3 ( 2012-03), p. 634-638
    Type of Medium: Online Resource
    ISSN: 0148-396X
    URL: Article
    DOI: 10.1227/NEU.0b013e3182320d1a
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 1491894-8
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