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1. Gadolinium-enhanced intracranial aneurysm wall imaging and risk of aneurysm growth and rupture: a multicentre longitudinal cohort study

Author

van der Kamp, Laura T., Edjlali, Myriam, Naggara, Olivier, Matsushige, Toshinori, Bulters, Diederik O., Digpal, Ronneil, Zhu, Chengcheng, Saloner, David, Hu, Peng, Zhai, Xiaodong, Mossa-Basha, Mahmud, Tian, Bing, Sakamoto, Shigeyuki, Fu, Qichang, Ruigrok, Ynte M., Zhao, Huilin, Chen, Huijun, Rinkel, Gabriel J. E., van der Schaaf, Irene C., and Vergouwen, Mervyn D. I.

Published
2024
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2. Risk of Early Versus Later Rebleeding From Dural Arteriovenous Fistulas With Cortical Venous Drainage

Author

Durnford, Andrew J, Akarca, Danyal, Culliford, David, Millar, John, Guniganti, Ridhima, Giordan, Enrico, Brinjikji, Waleed, Chen, Ching-Jen, Abecassis, Isaac Josh, Levitt, Michael, Polifka, Adam J, Derdeyn, Colin P, Samaniego, Edgar A, Kwasnicki, Amanda, Alaraj, Ali, Potgieser, Adriaan RE, Chen, Stephanie, Tada, Yoshiteru, Phelps, Ryan, Abla, Adib, Satomi, Junichiro, Starke, Robert M, van Dijk, J Marc C, Amin-Hanjani, Sepideh, Hayakawa, Minako, Gross, Bradley, Fox, W Christopher, Kim, Louis, Sheehan, Jason, Lanzino, Giuseppe, Kansagra, Akash P, Du, Rose, Lai, Rosalind, Zipfel, Gregory J, Bulters, Diederik O, Piccirillo, Jay F, Raman, Hari, Lipsey, , Kim, Vine, Roanna, Cloft, Harry J, Kallmes, David F, Pollock, Bruce E, Link, Michael J, Patibandla, Mohana Rao, Ding, Dale, Buell, Thomas, Paisan, Gabriella, Meyer, R Michael, Kelly, , Cory, Duffill, Jonathan, Ditchfield, Adam, Macdonald, Jason, Laurent, Dimitri, Hoh, Brian, Smith, Jessica, Lockerman, Ashley, Lunsford, L Dade, Jankowitz, Brian T, Gutierrez, Santiago Ortega, Hasan, David, Roa, Jorge A, Rossen, James, Guerrero, Waldo, McGruder, Allen, Charbel, Fady T, Aletich, Victor A, Rose-Finnell, Linda, Peterson, Eric C, Yavagal, Dileep R, Sur, Samir, Kanematsu, Yasuhisa, Yamamoto, Nobuaki, Kinouchi, Tomoya, Korai, Masaaki, Yamaguchi, Izumi, Yamamoto, Yuki, Winkler, Ethan, Lawton, Michael, Rutkowski, Martin, Sultan, M Ali Aziz, Patel, Nirav, and Frerichs, Kai U

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Kidney Disease, Central Nervous System Vascular Malformations, Cerebral Angiography, Drainage, Embolization, Therapeutic, Humans, Outcome Assessment, Health Care, drainage, fistula, hemorrhage, incidence, natural history, CONDOR Investigators, Cardiorespiratory Medicine and Haematology, Neurosciences, Neurology & Neurosurgery, Clinical sciences, Allied health and rehabilitation science
Abstract

BackgroundCranial dural arteriovenous fistulas with cortical venous drainage are rare lesions that can present with hemorrhage. A high rate of rebleeding in the early period following hemorrhage has been reported, but published long-term rates are much lower. No study has examined how risk of rebleeding changes over time. Our objective was to quantify the relative incidence of rebleeding in the early and later periods following hemorrhage.MethodsPatients with dural arteriovenous fistula and cortical venous drainage presenting with hemorrhage were identified from the multinational CONDOR (Consortium for Dural Fistula Outcomes Research) database. Natural history follow-up was defined as time from hemorrhage to first treatment, rebleed, or last follow-up. Rebleeding in the first 2 weeks and first year were compared using incidence rate ratio and difference.ResultsOf 1077 patients, 250 met the inclusion criteria and had 95 cumulative person-years natural history follow-up. The overall annualized rebleed rate was 7.3% (95% CI, 3.2-14.5). The incidence rate of rebleeding in the first 2 weeks was 0.0011 per person-day; an early rebleed risk of 1.6% in the first 14 days (95% CI, 0.3-5.1). For the remainder of the first year, the incidence rate was 0.00015 per person-day; a rebleed rate of 5.3% (CI, 1.7-12.4) over 1 year. The incidence rate ratio was 7.3 (95% CI, 1.4-37.7; P, 0.026).ConclusionsThe risk of rebleeding of a dural arteriovenous fistula with cortical venous drainage presenting with hemorrhage is increased in the first 2 weeks justifying early treatment. However, the magnitude of this increase may be considerably lower than previously thought. Treatment within 5 days was associated with a low rate of rebleeding and appears an appropriate timeframe.

Published
2022

4. Gadolinium-enhanced intracranial aneurysm wall imaging and risk of aneurysm growth and rupture: a multicentre longitudinal cohort study

Author

Projectafdeling CVZ, Circulatory Health, Neurologen, Brain, MS Radiologie, van der Kamp, Laura T, Edjlali, Myriam, Naggara, Olivier, Matsushige, Toshinori, Bulters, Diederik O, Digpal, Ronneil, Zhu, Chengcheng, Saloner, David, Hu, Peng, Zhai, Xiaodong, Mossa-Basha, Mahmud, Tian, Bing, Sakamoto, Shigeyuki, Fu, Qichang, Ruigrok, Ynte M, Zhao, Huilin, Chen, Huijun, Rinkel, Gabriel J E, van der Schaaf, Irene C, Vergouwen, Mervyn D I, Projectafdeling CVZ, Circulatory Health, Neurologen, Brain, MS Radiologie, van der Kamp, Laura T, Edjlali, Myriam, Naggara, Olivier, Matsushige, Toshinori, Bulters, Diederik O, Digpal, Ronneil, Zhu, Chengcheng, Saloner, David, Hu, Peng, Zhai, Xiaodong, Mossa-Basha, Mahmud, Tian, Bing, Sakamoto, Shigeyuki, Fu, Qichang, Ruigrok, Ynte M, Zhao, Huilin, Chen, Huijun, Rinkel, Gabriel J E, van der Schaaf, Irene C, and Vergouwen, Mervyn D I

Published
2024

6. Dural Arteriovenous Fistulas With Cognitive Impairment: Angiographic Characteristics and Treatment Outcomes.

Author

Sanchez, Sebastian, Wendt, Linder, Hayakawa, Minako, Chen, Ching-Jen, Sheehan, Jason P., Kim, Louis J., Abecassis, Isaac Josh, Levitt, Michael R., Meyer, R. Michael, Guniganti, Ridhima, Kansagra, Akash P., Lanzino, Giuseppe, Giordan, Enrico, Brinjikji, Waleed, Bulters, Diederik O., Durnford, Andrew, Fox, W. Christopher, Smith, Jessica, Polifka, Adam J., and Gross, Bradley

Published
2024
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10. Haptoglobin genotype and aneurysmal subarachnoid hemorrhage: Individual patient data analysis

Author

Gaastra, Ben, Ren, Dianxu, Alexander, Sheila, Bennett, Ellen R., Bielawski, Dawn M., Blackburn, Spiros L., Borsody, Mark K., Doré, Sylvain, Galea, James, Garland, Patrick, He, Tian, Iihara, Koji, Kawamura, Yoichiro, Leclerc, Jenna L., Meschia, James F., Pizzi, Michael A., Tamargo, Rafael J., Yang, Wuyang, Nyquist, Paul A., Bulters, Diederik O., and Galea, Ian

Published
2019
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12. Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas.

Author

Sanchez, Sebastian, Raghuram, Ashrita, Wendt, Linder, Hayakawa, Minako, Ching-Jen Chen, Sheehan, Jason P., Kim, Louis J., Abecassis, Isaac Josh, Levitt, Michael R., Meyer, R. Michael, Guniganti, Ridhima, Kansagra, Akash P., Lanzino, Giuseppe, Giordan, Enrico, Brinjikji, Waleed, Bulters, Diederik O., Durnford, Andrew, Fox, W. Christopher, Smith, Jessica, and Polifka, Adam J.

Subjects
MICROSURGERY, INTRACRANIAL hemorrhage, THERAPEUTIC embolization, ARTERIOVENOUS fistula, TREATMENT effectiveness, COMPARATIVE studies, BLOOD-vessel abnormalities, DESCRIPTIVE statistics, ANGIOGRAPHY, SKULL base, ENDOVASCULAR surgery, DATA analysis software, LONGITUDINAL method, SYMPTOMS
Abstract

Background Anterior cranial fossa dural arteriovenous fistulas (ACF-dAVFs) are aggressive vascular lesions. The pattern of venous drainage is the most important determinant of symptoms. Due to the absence of a venous sinus in the anterior cranial fossa, most ACF-dAVFs have some degree of drainage through small cortical veins. We describe the natural history, angiographic presentation and outcomes of the largest cohort of ACF-dAVFs. Methods The CONDOR consortium includes data from 12 international centers. Patients included in the study were diagnosed with an arteriovenous fistula between 1990-2017. ACF-dAVFs were selected from a cohort of 1077 arteriovenous fistulas. The presentation, angioarchitecture and treatment outcomes of ACF-dAVF were extracted and analyzed. Results 60 ACF-dAVFs were included in the analysis. Most ACF-dAVFs were symptomatic (38/60, 63%). The most common symptomatic presentation was intracranial hemorrhage (22/38, 57%). Most ACF-dAVFs drained through cortical veins (85%, 51/60), which in most instances drained into the superior sagittal sinus (63%, 32/51). The presence of cortical venous drainage predicted symptomatic presentation (OR 9.4, CI 1.98 to 69.1, p=0.01). Microsurgery was the most effective modality of treatment. 56% (19/34) of symptomatic patients who were treated had complete resolution of symptoms. Improvement of symptoms was not observed in untreated symptomatic ACF-dAVFs. Conclusion Most ACF-dAVFs have a symptomatic presentation. Drainage through cortical veins is a key angiographic feature of ACF-dAVFs that accounts for their malignant course. Microsurgery is the most effective treatment. Due to the high risk of bleeding, closure of ACF-dAVFs is indicated regardless of presentation. [ABSTRACT FROM AUTHOR]

Published
2023
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13. Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland

Author

Jamjoom, Aimun A B, Joannides, Alexis J, Poon, Michael Tin-Chung, Chari, Aswin, Zaben, Malik, Abdulla, Mutwakil A H, Roach, Joy, Glancz, Laurence J, Solth, Anna, Duddy, John, Brennan, Paul M, Bayston, Roger, Bulters, Diederik O, Mallucci, Conor L, Jenkinson, Michael D, Gray, William P, Kandasamy, Jothy, Hutchinson, Peter J, Kolias, Angelos G, Ahmed, Aminul I, Alalade, A, Bailey, M, Basu, S, Baudracco, I, Bhattacharya, A, Bodkin, Pa, Boissaud-cooke, M, Bojanic, S, Buxton, N, Corns, R, Coulter, C, Coulter, I, Critchley, G, Dando, A, Dardis, R, Dyson, E, Edwards, R, Garnett, M, Gatcher, S, Georges, H, Hallet, J, Harte, J, Haylock-vize, P, Humphreys, H, Kitchen, J, Lawson Mclean, A, Loan, JJM, Ma, R, Madder, H, Manning, A, Mcelligott, S, Mukerji, N, Narayanamurthy, H, O’brien, D, Okasha, M, Papadopoulos, M, Phan, V, Phang, I, Poots, J, Rajaraman, C, Ross, N, Sharouf, F, Shastin, D, Simms, N, Steele, L, Tajsic, T, Talibi, S, Thanabalasundaram, G, Vintu, M, Wan, Y, Wang, D, Watkins, L, Whitehouse, K, Whitfield, PC, and Williams, A

Published
2018
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14. Evaluation of Outcomes Among Patients With Traumatic Intracranial Hypertension Treated With Decompressive Craniectomy vs Standard Medical Care at 24 Months: A Secondary Analysis of the RESCUEicp Randomized Clinical Trial

Author

Kolias, Angelos G., Adams, Hadie, Timofeev, Ivan S., Corteen, Elizabeth A., Hossain, Iftakher, Czosnyka, Marek, Timothy, Jake, Anderson, Ian, Bulters, Diederik O., Belli, Antonio, Eynon, C. Andrew, Wadley, John, Mendelow, A. David, Mitchell, Patrick M., Wilson, Mark H., Critchley, Giles, Sahuquillo, Juan, Unterberg, Andreas, Posti, Jussi P., Servadei, Franco, Teasdale, Graham M., Pickard, John D., Menon, David K., Murray, Gordon D., Kirkpatrick, Peter J., and Hutchinson, Peter J.

Subjects
Adult, Male, Decompressive Craniectomy, Adolescent, Persistent Vegetative State, Middle Aged, Young Adult, Treatment Outcome, Brain Injuries, Brain Injuries, Traumatic, Humans, Female, Neurology (clinical), Intracranial Hypertension, Child, Original Investigation, Aged
Abstract

IMPORTANCE: Trials often assess primary outcomes of traumatic brain injury at 6 months. Longer-term data are needed to assess outcomes for patients receiving surgical vs medical treatment for traumatic intracranial hypertension. OBJECTIVE: To evaluate 24-month outcomes for patients with traumatic intracranial hypertension treated with decompressive craniectomy or standard medical care. DESIGN, SETTING, AND PARTICIPANTS: Prespecified secondary analysis of the Randomized Evaluation of Surgery With Craniectomy for Uncontrollable Elevation of Intracranial Pressure (RESCUEicp) randomized clinical trial data was performed for patients with traumatic intracranial hypertension (>25 mm Hg) from 52 centers in 20 countries. Enrollment occurred between January 2004 and March 2014. Data were analyzed between 2018 and 2021. Eligibility criteria were age 10 to 65 years, traumatic brain injury (confirmed via computed tomography), intracranial pressure monitoring, and sustained and refractory elevated intracranial pressure for 1 to 12 hours despite pressure-controlling measures. Exclusion criteria were bilateral fixed and dilated pupils, bleeding diathesis, or unsurvivable injury. INTERVENTIONS: Patients were randomly assigned 1:1 to receive a decompressive craniectomy with standard care (surgical group) or to ongoing medical treatment with the option to add barbiturate infusion (medical group). MAIN OUTCOMES AND MEASURES: The primary outcome was measured with the 8-point Extended Glasgow Outcome Scale (1 indicates death and 8 denotes upper good recovery), and the 6- to 24-month outcome trajectory was examined. RESULTS: This study enrolled 408 patients: 206 in the surgical group and 202 in the medical group. The mean (SD) age was 32.3 (13.2) and 34.8 (13.7) years, respectively, and the study population was predominantly male (165 [81.7%] and 156 [80.0%], respectively). At 24 months, patients in the surgical group had reduced mortality (61 [33.5%] vs 94 [54.0%]; absolute difference, −20.5 [95% CI, −30.8 to −10.2]) and higher rates of vegetative state (absolute difference, 4.3 [95% CI, 0.0 to 8.6]), lower or upper moderate disability (4.7 [−0.9 to 10.3] vs 2.8 [−4.2 to 9.8]), and lower or upper severe disability (2.2 [−5.4 to 9.8] vs 6.5 [1.8 to 11.2]; χ(2)(7) = 24.20, P = .001). For every 100 individuals treated surgically, 21 additional patients survived at 24 months; 4 were in a vegetative state, 2 had lower and 7 had upper severe disability, and 5 had lower and 3 had upper moderate disability, respectively. Rates of lower and upper good recovery were similar for the surgical and medical groups (20 [11.0%] vs 19 [10.9%]), and significant differences in net improvement (≥1 grade) were observed between 6 and 24 months (55 [30.0%] vs 25 [14.0%]; χ(2)(2) = 13.27, P = .001). CONCLUSIONS AND RELEVANCE: At 24 months, patients with surgically treated posttraumatic refractory intracranial hypertension had a sustained reduction in mortality and higher rates of vegetative state, severe disability, and moderate disability. Patients in the surgical group were more likely to improve over time vs patients in the medical group. TRIAL REGISTRATION: ISRCTN Identifier: 66202560

Published
2022

15. Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas

Author

Sanchez, Sebastian, primary, Raghuram, Ashrita, additional, Wendt, Linder, additional, Hayakawa, Minako, additional, Chen, Ching-Jen, additional, Sheehan, Jason P, additional, Kim, Louis J, additional, Abecassis, Isaac Josh, additional, Levitt, Michael R, additional, Meyer, R Michael, additional, Guniganti, Ridhima, additional, Kansagra, Akash P, additional, Lanzino, Giuseppe, additional, Giordan, Enrico, additional, Brinjikji, Waleed, additional, Bulters, Diederik O, additional, Durnford, Andrew, additional, Fox, W Christopher, additional, Smith, Jessica, additional, Polifka, Adam J, additional, Gross, Bradley, additional, Amin-Hanjani, Sepideh, additional, Alaraj, Ali, additional, Kwasnicki, Amanda, additional, Starke, Robert M, additional, Chen, Stephanie H, additional, van Dijk, J Marc C, additional, Potgieser, Adriaan R E, additional, Satomi, Junichiro, additional, Tada, Yoshiteru, additional, Phelps, Ryan, additional, Abla, Adib, additional, Winkler, Ethan, additional, Du, Rose, additional, Lai, Pui Man Rosalind, additional, Zipfel, Gregory J, additional, Derdeyn, Colin, additional, and Samaniego, Edgar A, additional

Published
2022
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16. Iron Deposition in the Brain After Aneurysmal Subarachnoid Hemorrhage

Author

Galea, Ian, primary, Durnford, Andrew, additional, Glazier, James, additional, Mitchell, Sophie, additional, Kohli, Suraj, additional, Foulkes, Lesley, additional, Norman, Jeanette, additional, Darekar, Angela, additional, Love, Seth, additional, Bulters, Diederik O., additional, Nicoll, James A.R., additional, and Boche, Delphine, additional

Published
2022
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22. Onyx embolization for dural arteriovenous fistulas: a multi-institutional study

Author

Li, Yangchun, primary, Chen, Stephanie H, additional, Guniganti, Ridhima, additional, Kansagra, Akash P, additional, Piccirillo, Jay F, additional, Chen, Ching-Jen, additional, Buell, Thomas, additional, Sheehan, Jason P, additional, Ding, Dale, additional, Lanzino, Giuseppe, additional, Brinjikji, Waleed, additional, Kim, Louis J, additional, Levitt, Michael R, additional, Abecassis, Isaac Josh, additional, Bulters, Diederik O, additional, Durnford, Andrew, additional, Fox, W Christopher, additional, Polifka, Adam J, additional, Gross, Bradley A., additional, Sur, Samir, additional, McCarthy, David J, additional, Yavagal, Dileep R, additional, Peterson, Eric C, additional, Hayakawa, Minako, additional, Derdeyn, Colin, additional, Samaniego, Edgar A, additional, Amin-Hanjani, Sepideh, additional, Alaraj, Ali, additional, Kwasnicki, Amanda, additional, Charbel, Fady T, additional, van Dijk, J Marc C, additional, Potgieser, Adriaan RE, additional, Satomi, Junichiro, additional, Tada, Yoshiteru, additional, Abla, Adib, additional, Phelps, Ryan, additional, Du, Rose, additional, Lai, Pui Man Rosalind, additional, Zipfel, Gregory J, additional, and Starke, Robert M, additional

Published
2021
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24. Sonic Hedgehog Signaling Promotes Peri-Lesion Cell Proliferation and Functional Improvement after Cortical Contusion Injury

Author

Pringle, Ashley K., primary, Solomon, Elshadaie, additional, Coles, Benjamin J., additional, Desousa, Brandon R., additional, Shtaya, Anan, additional, Gajavelli, Shyam, additional, Dabab, Nedal, additional, Zaben, Malik J., additional, Bulters, Diederik O., additional, Bullock, M. Ross, additional, and Ahmed, Aminul I., additional

Published
2021
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25. Assessing the Rate, Natural History, and Treatment Trends of Intracranial Aneurysms in Patients with Cranial Dural Arteriovenous Fistulae (dAVF); A CONDOR Investigation

Author

Abecassis, Isaac J, primary, Meyer, R. Michael, additional, Levitt, Michael R, additional, Sheehan, Jason P, additional, Chen, Ching-Jen, additional, Gross, Bradley A, additional, Lockerman, Ashley, additional, Fox, W. Christopher, additional, Giordan, Enrico, additional, Lanzino, Giuseppe, additional, Starke, Robert M, additional, Chen, Stephanie H, additional, Potgieser, Adriaan R. E, additional, van Dijk, J.M.C, additional, Durnford, Andrew, additional, Bulters, Diederik O, additional, Satomi, Junichiro, additional, Tada, Yoshiteru, additional, Kwasnicki, Amanda M, additional, Amin-Hanjani, Sepideh, additional, Alaraj, Ali, additional, Samaniego, Edgar A, additional, Hayakawa, Minako, additional, Derdeyn, Colin P, additional, Winkler, Ethan A, additional, Abla, Adib A, additional, Lai, Pui Man Rosalind, additional, Du, Rose, additional, Guniganti, Ridhima R, additional, Kansagra, Akash P, additional, Zipfel, Gregory J, additional, and Kim, Louis J, additional

Published
2020
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27. Haptoglobin genotype and outcome after aneurysmal subarachnoid haemorrhage

Author

Morton, Matthew J, primary, Hostettler, Isabel C, additional, Kazmi, Nabila, additional, Alg, Varinder S, additional, Bonner, Stephen, additional, Brown, Martin M, additional, Durnford, Andrew, additional, Gaastra, Benjamin, additional, Garland, Patrick, additional, Grieve, Joan, additional, Kitchen, Neil, additional, Walsh, Daniel, additional, Zolnourian, Ardalan, additional, Houlden, Henry, additional, Gaunt, Tom R, additional, Bulters, Diederik O, additional, Werring, David J, additional, and Galea, Ian, additional

Published
2020
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28. Haptoglobin genotype and outcome after spontaneous intracerebral haemorrhage

Author

Hostettler, Isabel Charlotte, primary, Morton, Matthew J, additional, Ambler, Gareth, additional, Kazmi, Nabila, additional, Gaunt, Tom, additional, Wilson, Duncan, additional, Shakeshaft, Clare, additional, Jäger, H R, additional, Cohen, Hannah, additional, Yousry, Tarek A, additional, Al-Shahi Salman, Rustam, additional, Lip, Gregory, additional, Brown, Martin M, additional, Muir, Keith, additional, Houlden, Henry, additional, Bulters, Diederik O, additional, Galea, Ian, additional, and Werring, David J, additional

Published
2020
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29. Haemoglobin causes neuronal damage in vivo which is preventable by haptoglobin

Author

Garland, Patrick, primary, Morton, Matthew J, additional, Haskins, William, additional, Zolnourian, Ardalan, additional, Durnford, Andrew, additional, Gaastra, Ben, additional, Toombs, Jamie, additional, Heslegrave, Amanda J, additional, More, John, additional, Okemefuna, Azubuike I, additional, Teeling, Jessica L, additional, Graversen, Jonas H, additional, Zetterberg, Henrik, additional, Moestrup, Soren K, additional, Bulters, Diederik O, additional, and Galea, Ian, additional

Published
2020
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30. Onyx embolization for dural arteriovenous fistulas: a multi- institutional study.

Author

Yangchun Li, Chen, Stephanie H., Guniganti, Ridhima, Kansagra, Akash P., Piccirillo, Jay F., Ching-Jen Chen, Buell, Thomas, Sheehan, Jason P., Ding, Dale, Lanzino, Giuseppe, Brinjikji, Waleed, Kim, Louis J., Levitt, Michael R., Abecassis, Isaac Josh, Bulters, Diederik O., Durnford, Andrew, Fox, W. Christopher, Polifka, Adam J., Gross, Bradley A., and Sur, Samir

Subjects
NERVOUS system abnormalities, RESEARCH, PATIENT aftercare, BRAIN diseases, POLYSTYRENE, FUNCTIONAL status, AGE distribution, THERAPEUTIC embolization, MEDICAL cooperation, SURGERY, PATIENTS, INTERVENTIONAL radiology, ARTERIOVENOUS fistula, RISK assessment, DESCRIPTIVE statistics, LOGISTIC regression analysis, STATISTICAL models, DISEASE risk factors
Abstract

Background Although the liquid embolic agent, Onyx, is often the preferred embolic treatment for cerebral dural arteriovenous fistulas (DAVFs), there have only been a limited number of single-center studies to evaluate its performance. Objective To carry out a multicenter study to determine the predictors of complications, obliteration, and functional outcomes associated with primary Onyx embolization of DAVFs. Methods From the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database, we identified patients who were treated for DAVF with Onyx-only embolization as the primary treatment between 2000 and 2013. Obliteration rate after initial embolization was determined based on the final angiographic run. Factors predictive of complete obliteration, complications, and functional independence were evaluated with multivariate logistic regression models. Results A total 146 patients with DAVFs were primarily embolized with Onyx. Mean follow-up was 29 months (range 0-129 months). Complete obliteration was achieved in 80 (55%) patients after initial embolization. Major cerebral complications occurred in six patients (4.1%). At last followup, 84% patients were functionally independent. Presence of flow symptoms, age over 65, presence of an occipital artery feeder, and preprocedural home anticoagulation use were predictive of non-obliteration. The transverse-sigmoid sinus junction location was associated with fewer complications, whereas the tentorial location was predictive of poor functional outcomes. Conclusions In this multicenter study, we report satisfactory performance of Onyx as a primary DAVF embolic agent. The tentorium remains a more challenging location for DAVF embolization, whereas DAVFs located at the transverse- sigmoid sinus junction are associated with fewer complications. [ABSTRACT FROM AUTHOR]

Published
2022
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31. Prospective, Multi-Centre Study of External Ventricular Drainage-Related Infections in the United Kingdom and Ireland

Author

Jamjoom, Aimun, Joannides, Alexis, Poon, M., Chari, A., Zaben, M., Abdulla, M.A.H., Roach, J., Glancz, L.J., Solth, Anna, Duddy, J., Brennan, Paul, Bayston, R, Bulters, Diederik O, Mallucci, Conor L, Jenkinson, M.D., Gray, W.P., Kandamsay, J, Hutchinson, P.J., Kolias, A.G., Ahmed, A.I., and Loan, James

Subjects
Journal Article
Abstract

Objectives: External Ventricular Drain (EVD) insertion is a common neurosurgical procedure. EVD-related infection (ERI) is a major complication that can lead to morbidity and mortality. In this study, we aimed to establish a national ERI rate in the United Kingdom (UK) and Ireland and determine key factors influencing the infection risk. Methods: A prospective multi-centre cohort study of EVD insertions in 21 neurosurgical units was performed over 6 months. The primary outcome measure was 30-day ERI. A Cox Regression Model was used for multivariate analysis to calculate Hazard Ratios (HR). Results: A total of 495 EVD catheters were inserted into 452 patients with EVDs remaining in-situ for 4700 days (median 8 days; interquartile range 4-13). Of the catheters inserted, 188 (38%) were antibiotic-impregnated, 161 (32.5%) were plain and 146 (29.5%) were silver-bearing. A total of 46 ERIs occurred giving an infection risk of 9.3%. Cox regression analysis demonstrated that factors independently associated with increased infection risk included duration of EVD placement for ≥8 days [HR=2.47 (1.12-5.45); p=0.03], regular sampling (daily sampling [HR=4.73 (1.28-17.42), p=0.02] and alternate day sampling [HR=5.28 (2.25-12.38); p

Published
2017

32. The heme-hemopexin scavenging system is active in the brain, and associates with outcome after subarachnoid hemorrhage

Author

Garland, Patrick, Durnford, Andrew J., Okemefuna, Azubuike I., Dunbar, John, Nicoll, James A.R., Galea, James, Boche, Delphine, Bulters, Diederik O., and Galea, Ian

Subjects
cardiovascular diseases, nervous system diseases
Abstract

Background and Purpose – Long-term outcome after subarachnoid hemorrhage (SAH) is potentially linked to cytotoxic heme. Free heme is bound by hemopexin (Hpx) and rapidly scavenged by CD91. We hypothesized that heme scavenging in the brain would be associated with outcome after haemorrhage. Methods - Using cerebrospinal fluid (CSF) and tissue from SAH patients and control individuals, the activity of the intracranial CD91-Hpx system was examined using enzyme-linked immunoassays, ultra-high performance liquid chromatography and immunohistochemistry. Results - In control individuals, CSF Hpx was mainly synthesized intrathecally. After SAH, CSF Hpx was high in one-third of cases, and these patients had a higher probability of delayed cerebral ischaemia and poorer neurological outcome. The intracranial CD91-Hpx system was active after SAH since CD91 positively correlated with iron deposition in brain tissue. Heme-Hpx uptake saturated rapidly after SAH, since bound heme accumulated early in the CSF. When the blood-brain barrier was compromised following SAH, serum Hpx level was lower, suggesting heme transfer to the circulation for peripheral CD91 scavenging. Conclusions - The CD91-heme-Hpx scavenging system is important after SAH and merits further study as a potential prognostic marker and therapeutic target.

Published
2016

33. Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland

Author

Jamjoom, Aimun A B, primary, Joannides, Alexis J, additional, Poon, Michael Tin-Chung, additional, Chari, Aswin, additional, Zaben, Malik, additional, Abdulla, Mutwakil A H, additional, Roach, Joy, additional, Glancz, Laurence J, additional, Solth, Anna, additional, Duddy, John, additional, Brennan, Paul M, additional, Bayston, Roger, additional, Bulters, Diederik O, additional, Mallucci, Conor L, additional, Jenkinson, Michael D, additional, Gray, William P, additional, Kandasamy, Jothy, additional, Hutchinson, Peter J, additional, Kolias, Angelos G, additional, and Ahmed, Aminul I, additional

Published
2017
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34. Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension

Author

Hutchinson, Peter J., primary, Kolias, Angelos G., additional, Timofeev, Ivan S., additional, Corteen, Elizabeth A., additional, Czosnyka, Marek, additional, Timothy, Jake, additional, Anderson, Ian, additional, Bulters, Diederik O., additional, Belli, Antonio, additional, Eynon, C. Andrew, additional, Wadley, John, additional, Mendelow, A. David, additional, Mitchell, Patrick M., additional, Wilson, Mark H., additional, Critchley, Giles, additional, Sahuquillo, Juan, additional, Unterberg, Andreas, additional, Servadei, Franco, additional, Teasdale, Graham M., additional, Pickard, John D., additional, Menon, David K., additional, Murray, Gordon D., additional, and Kirkpatrick, Peter J., additional

Published
2016
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35. Pharmacologic Management of Subarachnoid Hemorrhage

Author

Young, Adam M.H., primary, Karri, Surya K., additional, Helmy, Adel, additional, Budohoski, Karol P., additional, Kirollos, Ramez W., additional, Bulters, Diederik O., additional, Kirkpatrick, Peter J., additional, Ogilvy, Christopher S., additional, and Trivedi, Rikin A., additional

Published
2015
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43. The SILVER Trial

Author

Har Keong MRCS, Nicole Chwee, primary, Bulters, Diederik O., additional, Richards, Hugh, additional, Farrington, Mark, additional, Sparrow, Owen, additional, Hutchinson, Peter J., additional, Pickard, John Douglas, additional, and Kirkpatrick, Peter J., additional

Published
2010
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45. Recovery of oculomotor nerve palsy secondary to posterior communicating artery aneurysms*.

Author

Patel, Krunal, Guilfoyle, Mathew R., Bulters, Diederik O., Kirollos, Ramez W., Antoun, Nagui M., Higgins, J. Nicholas P., Kirkpatrick, Peter J., and Trivedi, Rikin A.

Subjects
OCULOMOTOR nerve, MICROSURGERY, MEDICAL records, ANEURYSMS, SURGERY
Abstract

Background. Recent studies suggest more favourable recovery of oculomotor nerve palsy (ONP) caused by posterior communicating artery (PComA) aneurysms with microsurgical clipping compared to endovascular coiling. We describe a consecutive series of patients with ONP from PComA aneurysms treated by microsurgical clipping or endovascular coiling. Methods. We retrospectively reviewed medical records of all patients from 2005 to 2009 with complete or partial ONP from PComA aneurysms. Results. Twenty patients were identified, three with unruptured aneurysms. Two patients with ruptured aneurysms were unfit for treatment and therefore excluded. Of the 18 patients included (15 female), 9 underwent microsurgical clipping and 9 received endovascular coiling. Patients treated by surgical clipping were significantly younger compared to those treated by endovascular coiling (mean 52.3 vs. 67.9 years; p = 0.039). Five patients had incomplete ONP (3 clipped, 2 coiled) and thirteen had complete ONP. At 6 months, six of nine patients treated with clipping and five of nine patients treated with coiling had complete resolution of their ONP (p = 1.0); the remainder had partial improvement. There was no significant difference in duration of pre-treatment ONP, age, sex or status of aneurysm (ruptured or unruptured) between patients in the two groups or between those with full or partial recovery. However, all 5 patients with incomplete ONP at presentation recovered fully, compared with 6 of 13 patients who presented with complete ONP. Conclusions. We found no significant difference between clipping and coiling in the recovery of ONP due to PComA aneurysms. Patient who present with incomplete ONP are more likely to have a full recovery of ONP following either treatment modality than those who present with complete ONP. [ABSTRACT FROM AUTHOR]

Published
2014
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46. Proposal for establishment of the UK Cranial Reconstruction Registry (UKCRR).

Author

Kolias, Angelos G., Bulters, Diederik O., Cowie, Christopher J., Wilson, Mark H., Afshari, Fardad T., Helmy, Adel, Broughton, Ellie, Joannides, Alexis J., Zebian, Bassel, Harrisson, Stuart E., Hill, Ciaran S., Ahmed, Animul I., Barone, Damiano G., Thakur, Bhaskar, McMahon, Catherine J., Adlam, David M., Bentley, Robert P., Tolias, Christos M., Mitchell, Patrick M., and Whitfield, Peter C.

Subjects
*DECOMPRESSIVE craniectomy, *BRAIN injury treatment, *INTRACRANIAL hypertension, *HEALTH outcome assessment
Abstract

Background. The increasing utilisation of decompressive craniectomy for traumatic brain injury and stroke has led to an increase in the number of cranioplasties undertaken. Cranioplasty is also undertaken following excision of tumours originating from or invading the skull vault, removal of bone flaps due to post-operative infection, and decompressive craniectomy for the management of rarer causes of brain oedema and/or refractory intracranial hypertension. The existing literature which mainly consists of single-centre, retrospective studies, shows a significant variation in practice patterns and a wide range of morbidity. There also exists a need to measure the outcome as perceived by the patients themselves with patient reported outcome measures (PROMs; functional outcome, quality of life, satisfaction with cosmesis). In the UK, the concept of long-term surveillance of neurosurgical implants is well established with the UK shunt registry. Based on this background, we propose to establish the UK Cranial Reconstruction Registry (UKCRR). Aim. The overarching aim of the UKCRR is to collect high-quality data about cranioplasties undertaken across the UK and Ireland in order to improve outcomes for patients. Methods. Any patient undergoing reconstruction of the skull vault with autologous bone, titanium, or synthetic material in participating units will be eligible for inclusion. Data will be submitted directly by participating units to the Outcome Registry Intervention and Operation Network secure platform. A Steering Committee will be responsible for overseeing the strategic direction and running of the UKCRR. Outcome measures. These will include re-operation due to a cranioplasty-related issue, surgical site infection, re-admission due to a cranioplasty-related issue, unplanned post-operative escalation of care, adverse events, length of stay in admitting unit, destination at discharge from admitting unit, mortality at discharge from admitting unit, neurological status and PROMs during routine follow-up. Conclusion. The UKCRR will be an important pillar in the ongoing efforts to optimise the outcomes of patients undergoing cranioplasty. [ABSTRACT FROM AUTHOR]

Published
2014
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49. Onyx embolization for dural arteriovenous fistulas: a multi-institutional study

Author

Li, Yangchun, Chen, Stephanie H, Guniganti, Ridhima, Kansagra, Akash P, Piccirillo, Jay F, Chen, Ching-Jen, Buell, Thomas, Sheehan, Jason P, Ding, Dale, Lanzino, Giuseppe, Brinjikji, Waleed, Kim, Louis J, Levitt, Michael R, Abecassis, Isaac Josh, Bulters, Diederik O, Durnford, Andrew, Fox, W Christopher, Polifka, Adam J, Gross, Bradley A., Sur, Samir, McCarthy, David J, Yavagal, Dileep R, Peterson, Eric C, Hayakawa, Minako, Derdeyn, Colin, Samaniego, Edgar A, Amin-Hanjani, Sepideh, Alaraj, Ali, Kwasnicki, Amanda, Charbel, Fady T, van Dijk, J Marc C, Potgieser, Adriaan RE, Satomi, Junichiro, Tada, Yoshiteru, Abla, Adib, Phelps, Ryan, Du, Rose, Lai, Pui Man Rosalind, Zipfel, Gregory J, and Starke, Robert M

Abstract

BackgroundAlthough the liquid embolic agent, Onyx, is often the preferred embolic treatment for cerebral dural arteriovenous fistulas (DAVFs), there have only been a limited number of single-center studies to evaluate its performance.ObjectiveTo carry out a multicenter study to determine the predictors of complications, obliteration, and functional outcomes associated with primary Onyx embolization of DAVFs.MethodsFrom the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database, we identified patients who were treated for DAVF with Onyx-only embolization as the primary treatment between 2000 and 2013. Obliteration rate after initial embolization was determined based on the final angiographic run. Factors predictive of complete obliteration, complications, and functional independence were evaluated with multivariate logistic regression models.ResultsA total 146 patients with DAVFs were primarily embolized with Onyx. Mean follow-up was 29 months (range 0–129 months). Complete obliteration was achieved in 80 (55%) patients after initial embolization. Major cerebral complications occurred in six patients (4.1%). At last follow-up, 84% patients were functionally independent. Presence of flow symptoms, age over 65, presence of an occipital artery feeder, and preprocedural home anticoagulation use were predictive of non-obliteration. The transverse-sigmoid sinus junction location was associated with fewer complications, whereas the tentorial location was predictive of poor functional outcomes.ConclusionsIn this multicenter study, we report satisfactory performance of Onyx as a primary DAVF embolic agent. The tentorium remains a more challenging location for DAVF embolization, whereas DAVFs located at the transverse-sigmoid sinus junction are associated with fewer complications.

Published
2022
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50. Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland

Author

Jamjoom, Aimun AB, Joannides, Alexis J, Poon, Michael Tin-Chung, Chari, Aswin, Zaben, Malik, Abdulla, Mutwakil AH, Roach, Joy, Glancz, Laurence J, Solth, Anna, Duddy, John, Brennan, Paul M, Bayston, Roger, Bulters, Diederik O, Mallucci, Conor L, Jenkinson, Michael D, Gray, William P, Kandasamy, Jothy, Hutchinson, Peter J, Kolias, Angelos G, Ahmed, Aminul I, and British Neurosurgical Trainee Research Collaborative

Subjects
Adult, Aged, 80 and over, Male, Adolescent, Infant, Newborn, Infant, Middle Aged, Staphylococcal Infections, Neurosurgical Procedures, United Kingdom, 3. Good health, Cerebral Ventricles, Ventriculostomy, Young Adult, Catheters, Indwelling, Postoperative Complications, Catheter-Related Infections, Child, Preschool, Humans, Female, Prospective Studies, Child, Ireland, Aged, Proportional Hazards Models
Abstract

OBJECTIVES: External ventricular drain (EVD) insertion is a common neurosurgical procedure. EVD-related infection (ERI) is a major complication that can lead to morbidity and mortality. In this study, we aimed to establish a national ERI rate in the UK and Ireland and determine key factors influencing the infection risk. METHODS: A prospective multicentre cohort study of EVD insertions in 21 neurosurgical units was performed over 6 months. The primary outcome measure was 30-day ERI. A Cox regression model was used for multivariate analysis to calculate HR. RESULTS: A total of 495 EVD catheters were inserted into 452 patients with EVDs remaining in situ for 4700 days (median 8 days; IQR 4-13). Of the catheters inserted, 188 (38%) were antibiotic-impregnated, 161 (32.5%) were plain and 146 (29.5%) were silver-bearing. A total of 46 ERIs occurred giving an infection risk of 9.3%. Cox regression analysis demonstrated that factors independently associated with increased infection risk included duration of EVD placement for ≥8 days (HR=2.47 (1.12-5.45); p=0.03), regular sampling (daily sampling (HR=4.73 (1.28-17.42), p=0.02) and alternate day sampling (HR=5.28 (2.25-12.38); p

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