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3.
Oper Neurosurg (Hagerstown) ; 20(2): 174-182, 2021 01 13.
Article in English | MEDLINE | ID: covidwho-1455340

ABSTRACT

BACKGROUND: Carotid-cavernous fistulas (CCFs) are acquired pathological shunting lesions between the carotid artery and the cavernous sinus leading to elevated intraocular pressure (IOP). CCFs are commonly treated via endovascular embolization, which theoretically restores physiological pressure differentials. OBJECTIVE: To present our institutional data with CCF treated with embolization and discuss endovascular routes, recurrence rates, and dynamic IOP changes. METHODS: Retrospective analysis of 42 CCF patients who underwent Onyx (Covidien, Irvine, California) embolization and pre- and postoperative IOP measurement at a single institution. RESULTS: CCFs were 19.0% direct (type A) and 81.0% indirect (types B, C, or D). Onyx-18 liquid embolisate was used during all embolizations. Overall rate of total occlusion was 83.3% and was statistically similar between direct and indirect fistulas. Preoperative IOP was elevated in 37.5%, 100.0%, 75.0%, and 50% in type A, B, C, and D fistulas, respectively. Average ΔIOP was -7.3 ± 8.5 mmHg (range: -33 to +8). Follow-up time was 4.64 ± 7.62 mo. Full angiographic occlusion was a predictor of symptom resolution at 1 mo (P = .026) and 6 mo (P = .021). Partial occlusion was associated with persistent symptoms postoperatively at 1 mo (P = .038) and 6 mo follow-up (P = .012). Beyond 6 mo, negative ΔIOP was associated with continued symptom improvement. Recurrence occurred in 9.5% of patients, all of which were indirect CCFs. CONCLUSION: Onyx embolization of CCF is an effective treatment for CCF and often results in the reversal of IOP elevation. Full occlusion predicts favorable clinical outcomes up to 6 mo. Postoperative IOP reduction may indicate favorable long-term clinical outcomes.


Subject(s)
Carotid-Cavernous Sinus Fistula , Cavernous Sinus , Embolization, Therapeutic , Carotid-Cavernous Sinus Fistula/diagnostic imaging , Carotid-Cavernous Sinus Fistula/therapy , Humans , Intraocular Pressure , Retrospective Studies
4.
Clin Neurol Neurosurg ; 206: 106677, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1230410

ABSTRACT

Owing to systemic inflammation and widespread vessel endotheliopathy, SARS-CoV-2 has been shown to confer an increased risk of cryptogenic stroke, particularly in patients without any traditional risk factors. In this report, we present a case of a 67-year-old female who presented with acute stroke from bilateral anterior circulation large vessel occlusions, and was incidentally found to be COVID-positive on routine hospital admission screening. The patient had a large area of penumbra bilaterally, and the decision was made to pursue bilateral simultaneous thrombectomy, with two endovascular neurosurgeons working on each side to achieve a faster time to recanalization. Our study highlights the utility and efficacy of simultaneous bilateral thrombectomy, and this treatment paradigm should be considered for use in patients who present with multifocal large vessel occlusions.


Subject(s)
COVID-19/complications , Carotid Artery Thrombosis/surgery , Endovascular Procedures , Infarction, Middle Cerebral Artery/surgery , Stroke/etiology , Thrombectomy , Aged , Carotid Artery Thrombosis/diagnosis , Carotid Artery Thrombosis/etiology , Female , Humans , Infarction, Middle Cerebral Artery/diagnosis , Infarction, Middle Cerebral Artery/etiology
7.
World Neurosurg ; 146: 20-25, 2021 02.
Article in English | MEDLINE | ID: covidwho-894259

ABSTRACT

The COVID-19 outbreak has led to fundamental disruptions of health care and its delivery with sweeping implications for patients and physicians of all specialties, including neurosurgery. In an effort to conserve hospital resources, neurosurgical procedures were classified into tiers to determine which procedures have to be performed in a timely fashion and which ones can be temporarily suspended to aid in the hospital's reallocation of resources when equipment is scarce. These guidelines were created quickly based on little existing evidence, and thus were initially variable and required refinement. As the early wave can now be assessed in retrospect, the authors describe the lessons learned and the protocols established based on published global evidence to continue to practice neurosurgery sensibly and minimize disruptions. These operational protocols can be applied in a surge of COVID-19 or another airborne pandemic.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Neurosurgical Procedures/standards , Practice Guidelines as Topic/standards , Humans , Neurosurgery/standards , Neurosurgery/trends , Neurosurgical Procedures/trends , Pandemics/prevention & control , Personal Protective Equipment/standards , Personal Protective Equipment/trends
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