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Article ; Online: Endovascular Treatment of Ethmoidal Dural Arteriovenous Fistulas-Neuroendovascular Surgical Video Demonstration of 2 Cases: 2-Dimensional Operative Video.

Shakur, Sophia F / Alaraj, Ali

Operative neurosurgery (Hagerstown, Md.)

2018 Volume 15, Issue 2, Page(s) 241

Language	English
Publishing date	2018-07-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	2767575-0
ISSN	2332-4260 ; 2332-4252
ISSN (online)	2332-4260
ISSN	2332-4252
DOI	10.1093/ons/opx259
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Article ; Online: Percutaneous Transvenous Glue Embolization of a Large Mandibular Arteriovenous Malformation: Neuroendovascular 2-Dimensional Operative Video.

Shakur, Sophia F / Alaraj, Ali

Operative neurosurgery (Hagerstown, Md.)

2018 Volume 15, Issue 1, Page(s) 99

Language	English
Publishing date	2018-09-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2767575-0
ISSN	2332-4260 ; 2332-4252
ISSN (online)	2332-4260
ISSN	2332-4252
DOI	10.1093/ons/opx240
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Transarterial Glue Embolization and Covered Stenting of Large Carotid Body Tumor in Same Setting: Neuroendovascular Surgical Video.

Shakur, Sophia F / Brunozzi, Denise / Alaraj, Ali

World neurosurgery

2019 Volume 124, Page(s) 44

Abstract: Surgical resection is considered to be the treatment of choice for carotid body tumors. However, surgery can be complicated by intraoperative bleeding, injury to the internal carotid artery, and cerebral ischemia. Consequently, preoperative endovascular ... ...

Abstract	Surgical resection is considered to be the treatment of choice for carotid body tumors. However, surgery can be complicated by intraoperative bleeding, injury to the internal carotid artery, and cerebral ischemia. Consequently, preoperative endovascular strategies including transarterial or percutaneous embolization or covered carotid stenting may be used. These neuroendovascular techniques have been described infrequently in the literature. Here, we showcase transarterial glue embolization followed by covered carotid stenting of a large carotid body tumor in the same setting (Video 1). A 53-year-old male presented with a 6-cm pulsatile and enlarging neck mass, as well as swallowing difficulty. Craniofacial computed tomography scan and digital subtraction angiography were consistent with a carotid body tumor. It was decided to perform preoperative embolization. Using roadmap guidance, a Prowler microcatheter (Codman Neurovascular, Inc., Raynham, Massachusetts, USA) was navigated into a tumor feeder vessel and a dilute 12% concentration (mix of 1 mL glue, 7 mL ethiodized oil) of the liquid embolic agent N-BCA (N-butyl cyanoacrylate; Codman Neurovascular, Inc.) was injected and seen to cast the tumor. During embolization, dextrose 5% water was injected through the guide catheter to enhance glue penetration into the tumor bed. Then, 2 covered stents (iCAST, Atrium Medical Corporation, Hudson, New Hampshire, USA) were deployed within the cervical internal carotid artery extending from levels C1-C6, spanning the carotid bifurcation, and excluding the external carotid artery. The patient underwent surgical resection 8 weeks later. The patient recovered from the procedures without any complications. Informed consent for the procedure and publication was obtained.
Language	English
Publishing date	2019-01-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2018.12.135
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Zs.A 1159: Show issues

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Article ; Online: Glue Embolization with Guide Catheter Dextrose Push of Recurrent Dural Arteriovenous Fistula Previously Embolized with Onyx: Neuroendovascular Surgical Video.

Shakur, Sophia F / Brunozzi, Denise / Alaraj, Ali

World neurosurgery

2019 Volume 126, Page(s) 466

Abstract: Onyx (ethylene vinyl alcohol, ev3, Irvine, California, USA) is commonly used to treat dural arteriovenous fistulas (DAVFs) and presents several advantages over n-butyl cyanoacrylate glue (Codman Neurovascular Inc, Raynham, Massachusetts, USA) including ... ...

Abstract	Onyx (ethylene vinyl alcohol, ev3, Irvine, California, USA) is commonly used to treat dural arteriovenous fistulas (DAVFs) and presents several advantages over n-butyl cyanoacrylate glue (Codman Neurovascular Inc, Raynham, Massachusetts, USA) including slower, more controlled injections and better penetration via radial casting. However, Onyx is nonthrombogenic and may result in incomplete casting, recanalization, and DAVF recurrence. Here, we demonstrate glue embolization with guide catheter dextrose push of a recurrent DAVF previously embolized with Onyx. A 79-year-old female diagnosed with a Cognard IIA+B DAVF was successfully treated with transarterial Onyx injection. A 6-month follow-up angiogram, however, revealed recurrence of the DAVF with recanalization of the previously embolized draining vein. She subsequently underwent retreatment using glue embolization with a guide catheter dextrose push. Informed written consent was obtained. A Magic microcatheter (Balt Extrusion, Irvine, California, USA) was passed via a 6-French Envoy guide catheter (Codman Neurovascular) in the external carotid artery and was used to select the superficial temporal artery and then navigated distally through a transosseous connection into the dura. A dilute 12.5% concentration of glue was injected slowly and continuously and was seen to fill in spaces within the old Onyx material. Dextrose 5% in water was concomitantly injected through the guide catheter to ensure distal migration of the glue and occlusion of the draining vein. Glue embolization with dextrose push is a valuable treatment option for DAVF, especially in smaller recurrent feeders that can fill in the Onyx recanalized cast. The 6-month follow-up angiogram showed persistent occlusion of the dural fistula (Video 1).
MeSH term(s)	Adhesives/administration & dosage ; Aged ; Catheters ; Central Nervous System Vascular Malformations/therapy ; Dimethyl Sulfoxide/administration & dosage ; Embolization, Therapeutic/instrumentation ; Embolization, Therapeutic/methods ; Female ; Glucose ; Humans ; Polyvinyls/administration & dosage ; Treatment Outcome
Chemical Substances	Adhesives ; Onyx copolymer ; Polyvinyls ; Glucose (IY9XDZ35W2) ; Dimethyl Sulfoxide (YOW8V9698H)
Language	English
Publishing date	2019-03-09
Publishing country	United States
Document type	Case Reports ; Journal Article ; Video-Audio Media
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2019.02.181
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Pipeline Embolization of Giant Cavernous Internal Carotid Artery Aneurysm with Direct Carotid Puncture and Arteriotomy Closure Device: Neuroendovascular Surgical Video.

Brunozzi, Denise / Shakur, Sophia F / Alaraj, Ali

World neurosurgery

2018 Volume 123, Page(s) 40

Abstract: Flow diversion technology has revolutionized the treatment of complex anterior circulation cerebral aneurysms. However, vessel tortuosity and atherosclerotic disease may hamper the standard transfemoral access used in these procedures. Percutaneous ... ...

Abstract	Flow diversion technology has revolutionized the treatment of complex anterior circulation cerebral aneurysms. However, vessel tortuosity and atherosclerotic disease may hamper the standard transfemoral access used in these procedures. Percutaneous direct carotid puncture is a viable alternative, but adequate carotid closure must be achieved. Here, we present the first case of a giant partially thrombosed aneurysm of the cavernous internal carotid artery treated with a Pipeline embolization device (PED; ev3 Neurovascular, Irvine, California, USA) via direct carotid puncture. A 79-year-old female presented with bilateral giant cavernous internal carotid artery aneurysms. She was successfully treated with PED on the right side and failed treatment with PED on the left side using a transfemoral approach due to common carotid artery tortuosity. She was lost to follow-up but presented 3 years later with worsening left eye pain and ophthalmoplegia. Percutaneous direct carotid puncture was performed under ultrasound guidance, and a 6-French sheath was inserted. Using roadmap guidance, a Marksman microcatheter (ev3 Neurovascular) with the support of a Navien intermediate catheter (ev3 Neurovascular) was advanced into the left middle cerebral artery, and 4 PEDs were deployed within the paraclinoid and cavernous segments of the internal carotid artery to completely cover the neck of the aneurysm. Carotid closure was performed for the first time with a Mynx collagen plug device (AccessClosure, Inc., Mountain View, California, USA). The patient recovered from the procedure without any complications, and her ophthalmoplegia partially improved. Informed patient consent for the procedure and for publication was obtained (Video 1).
MeSH term(s)	Aged ; Blood Vessel Prosthesis ; Carotid Artery Diseases/diagnostic imaging ; Carotid Artery Diseases/surgery ; Carotid Artery, Internal/surgery ; Cerebral Angiography ; Embolization, Therapeutic/instrumentation ; Embolization, Therapeutic/methods ; Female ; Humans ; Punctures/methods
Language	English
Publishing date	2018-12-07
Publishing country	United States
Document type	Case Reports ; Journal Article ; Video-Audio Media
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2018.11.230
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 1159: Show issues

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Article ; Online: Middle cerebral artery pressure changes following Pipeline flow diversion.

Brunozzi, Denise / Shakur, Sophia F / Charbel, Fady T / Alaraj, Ali

Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences

2018 Volume 24, Issue 3, Page(s) 297–302

Abstract: Objective Pipeline embolization devices (PED) are commonly used for endovascular treatment of cerebral aneurysms but changes in intracranial hemodynamics after PED deployment are poorly understood. Here, we assess middle cerebral artery (MCA) and ... ...

Abstract	Objective Pipeline embolization devices (PED) are commonly used for endovascular treatment of cerebral aneurysms but changes in intracranial hemodynamics after PED deployment are poorly understood. Here, we assess middle cerebral artery (MCA) and systemic blood pressure before and after PED treatment. Methods Records of patients with cerebral aneurysms proximal to the internal carotid artery terminus treated with PED at our institution between 2015 and 2017 were retrospectively reviewed. Patients were included if ipsilateral MCA pressure measurements were available. Ipsilateral MCA pressure was transduced via the microcatheter before and after PED deployment. Systemic arterial blood pressure was also simultaneously recorded. MCA, systemic blood pressure, and ratios of MCA to systemic blood pressure values were compared before and after treatment among the study cohort using the two-sample paired Student t test. Results Fourteen patients were included. Mean age was 54 years. Among the entire cohort, the ratio of MCA to systemic systolic and mean blood pressure were significantly higher after treatment (respectively 0.76 vs. 0.69, p = 0.01, and 0.94 vs. 0.89, p = 0.03), and the ratio of MCA to systemic diastolic pressures showed an increasing trend (1.08 vs. 1.03, p = 0.09). The percentage of ratio increase was independent of aneurysm size ( r = -0.24, p = 0.42 for systolic ratio; r = -0.09, p = 0.74 for diastolic ratio; r = -0.09; p = 0.76 for mean ratio, respectively). Conclusions Following PED deployment, the ratio of ipsilateral MCA to systemic systolic and mean blood pressure increased. These pressure changes should be further evaluated in a larger sample size.
MeSH term(s)	Adult ; Aged ; Embolization, Therapeutic/instrumentation ; Female ; Hemodynamics/physiology ; Humans ; Intracranial Aneurysm/physiopathology ; Intracranial Aneurysm/therapy ; Male ; Middle Aged ; Middle Cerebral Artery/physiopathology ; Treatment Outcome
Language	English
Publishing date	2018-02-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	1354913-3
ISSN	2385-2011 ; 1591-0199 ; 1123-9344
ISSN (online)	2385-2011
ISSN	1591-0199 ; 1123-9344
DOI	10.1177/1591019918756583
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Article: Cerebral Vasospasm with Ischemia following a Spontaneous Spinal Subarachnoid Hemorrhage.

Shakur, Sophia F / Farhat, Hamad I

Case reports in medicine

2013 Volume 2013, Page(s) 934143

Abstract: Cerebral vasospasm is a well-known consequence of aneurysmal subarachnoid hemorrhage (SAH) triggered by blood breakdown products. Here, we present the first case of cerebral vasospasm with ischemia following a spontaneous spinal SAH. A 67-year-old woman, ...

Abstract	Cerebral vasospasm is a well-known consequence of aneurysmal subarachnoid hemorrhage (SAH) triggered by blood breakdown products. Here, we present the first case of cerebral vasospasm with ischemia following a spontaneous spinal SAH. A 67-year-old woman, who was on Coumadin for atrial fibrillation, presented with chest pain radiating to the back accompanied by headache and leg paresthesias. The international normalized ratio (INR) was 4.5. Ten hours after presentation, she developed loss of movement in both legs and lack of sensation below the umbilicus. Spine MRI showed intradural hemorrhage. Her coagulopathy was reversed, and she underwent T2 to T12 laminectomies. A large subarachnoid hematoma was evacuated. Given her complaint of headache preoperatively and the intraoperative finding of spinal SAH, a head CT was done postoperatively that displayed SAH in peripheral sulci. On postoperative day 5, she became obtunded. Brain MRI demonstrated focal restricted diffusion in the left frontoparietal area. Formal angiography revealed vasospasm in anterior cerebral arteries bilaterally and right middle cerebral artery. Vasospasm was treated, and she returned to baseline within 48 hours. Spontaneous spinal SAH can result in the same sequelae typically associated with aneurysmal SAH, and the clinician must have a degree of suspicion in such patients. The pathophysiological mechanisms underlying cerebral vasospasm may explain this unique case.
Language	English
Publishing date	2013-02-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	2502642-2
ISSN	1687-9635 ; 1687-9627
ISSN (online)	1687-9635
ISSN	1687-9627
DOI	10.1155/2013/934143
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Occlusion of Extracranial-Intracranial Bypass Anastomosis-Associated Aneurysms Following Contralateral High-Flow Extracranial-Intracranial Bypass in a Patient with Impaired Cerebrovascular Reserve.

Stapleton, Christopher J / Theiss, Peter / Arnone, Gregory D / Shakur, Sophia F / Charbel, Fady T

Operative neurosurgery (Hagerstown, Md.)

2019 Volume 18, Issue 6, Page(s) E243–E247

Abstract: Background and importance: Extracranial-intracranial (EC-IC) bypass anastomosis-associated aneurysms are rare sequelae of cerebral revascularization surgery. Although treatment paradigms are not well defined, clipping, trapping with revision bypass, and ...

Abstract	Background and importance: Extracranial-intracranial (EC-IC) bypass anastomosis-associated aneurysms are rare sequelae of cerebral revascularization surgery. Although treatment paradigms are not well defined, clipping, trapping with revision bypass, and donor vessel ligation represent the most common microsurgical approaches. Clinical presentation: A 53-yr-old male presented with cognitive decline, left extremity weakness, and left visual field blurriness. Computed tomographic angiography of head/neck demonstrated bilateral cervical internal carotid artery occlusion and magnetic resonance imaging of brain showed a small right parieto-occipital lobe infarct. The patient's symptoms worsened despite aggressive medical management. Therefore, a right superficial temporal artery to middle cerebral artery (STA-MCA) bypass was performed for flow augmentation. Follow-up digital subtraction angiography (DSA) approximately 1 yr after surgery noted 2 new aneurysms adjacent to the patent STA-MCA anastomosis. Perfusion imaging at that time showed persistently reduced blood flow in the left cerebral hemisphere. A left STA-MCA bypass was performed, and intraoperative blood flow measurements showed this to be a high-flow bypass. Follow-up DSA 4 mo later demonstrated involution of the right STA-MCA bypass and occlusion of the anastomosis-associated aneurysms with increased perfusion of the right cerebral hemisphere via collateral blood flow from the patent high-flow left STA-MCA bypass. At 7 mo following left STA-MCA bypass, the patient's neurological examination remained stable and perfusion imaging showed improved blood flow in the left cerebral hemisphere. Conclusion: We present a unique case in which a high-flow left EC-IC bypass with robust contralateral collateral blood flow was associated with subsequent occlusion of a right EC-IC bypass and 2 anastomosis-associated aneurysms in a patient with bilateral impaired cerebrovascular reserve.
MeSH term(s)	Anastomosis, Surgical ; Cerebral Revascularization ; Humans ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/surgery ; Male ; Middle Aged ; Middle Cerebral Artery/surgery ; Temporal Arteries/diagnostic imaging ; Temporal Arteries/surgery
Language	English
Publishing date	2019-09-10
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2767575-0
ISSN	2332-4260 ; 2332-4252
ISSN (online)	2332-4260
ISSN	2332-4252
DOI	10.1093/ons/opz249
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Ruptured posterior cerebral artery aneurysm presenting with a contralateral cranial nerve III palsy: A case report.

Chaudhry, Nauman S / Brunozzi, Denise / Shakur, Sophia F / Charbel, Fady T / Alaraj, Ali

Surgical neurology international

2018 Volume 9, Page(s) 52

Abstract: Background: Posterior cerebral artery aneurysms can frequently present with an ipsilateral cranial nerve III palsy.: Case description: We report the first case of a posterior cerebral artery aneurysm associated with a contralateral cranial nerve III ... ...

Abstract	Background: Posterior cerebral artery aneurysms can frequently present with an ipsilateral cranial nerve III palsy. Case description: We report the first case of a posterior cerebral artery aneurysm associated with a contralateral cranial nerve III palsy. A 64-year-old male presented with acute subarachnoid hemorrhage, Hunt and Hess grade 3, and a left-sided fixed and dilated pupil. Computed tomography scan showed hemorrhage, mainly within the left basal cisterns. Digital subtraction angiography revealed a right-sided P1-P2 junction aneurysm. Conclusions: This case demonstrates that, although the neurological exam can help pinpoint the location of a lesion, false localizing signs should be recognized.
Language	English
Publishing date	2018-03-01
Publishing country	United States
Document type	Case Reports
ISSN	2229-5097
ISSN	2229-5097
DOI	10.4103/sni.sni_430_17
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Article ; Online: Cerebral arteriovenous malformation draining vein stenosis is associated with atherosclerotic risk factors.

Mendoza-Elias, Nasya / Shakur, Sophia F / Charbel, Fady T / Alaraj, Ali

Journal of neurointerventional surgery

2017 Volume 10, Issue 8, Page(s) 788–790

Abstract: Objective: The pathogenesis of venous outflow stenosis associated with cerebral arteriovenous malformation (AVM) draining veins is poorly understood. We sought to determine the relationship between venous stenosis and atherosclerotic risk factors.: ... ...

Abstract	Objective: The pathogenesis of venous outflow stenosis associated with cerebral arteriovenous malformation (AVM) draining veins is poorly understood. We sought to determine the relationship between venous stenosis and atherosclerotic risk factors. Materials and methods: All patients with an AVM seen at our institution between 1990 and 2016 were retrospectively reviewed. Patients <18 years of age were excluded. Patients were classified into two groups based on the presence or absence of venous stenosis. Patient charts were reviewed for the following atherosclerotic risk factors: age >50 years, sex, race, hypertension, type 2 diabetes mellitus, hyperlipidemia, coronary artery disease, chronic kidney disease stage III, and cigarette smoking. The relationship between venous stenosis and atherosclerotic risk factors was assessed using univariate and multivariate analyses. Results: 278 patients were included (mean age 41 years, 55% men). Venous stenosis was present in 87 patients (31% of the cohort). The presence of venous stenosis was significantly associated with age >50 years (P=0.05), hypertension (P=0.05), diabetes (P=0.02), and hyperlipidemia (P=0.001). Multivariate analysis showed that hyperlipidemia (P=0.05) was predictive of draining vein stenosis. Conclusions: Venous stenosis is associated with several atherosclerotic risk factors, suggesting that cerebral AVM venous outflow stenosis occurs by a degenerative process. Additional studies can show whether these modifiable risk factors may be targeted to prevent draining vein stenosis and AVM rupture.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Angiography, Digital Subtraction/methods ; Arteriovenous Fistula/complications ; Arteriovenous Fistula/diagnostic imaging ; Cerebral Angiography/methods ; Cerebral Veins/diagnostic imaging ; Cohort Studies ; Constriction, Pathologic/complications ; Constriction, Pathologic/diagnostic imaging ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/diagnostic imaging ; Female ; Humans ; Intracranial Arteriosclerosis/complications ; Intracranial Arteriosclerosis/diagnostic imaging ; Intracranial Arteriovenous Malformations/complications ; Intracranial Arteriovenous Malformations/diagnostic imaging ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Young Adult
Language	English
Publishing date	2017-11-28
Publishing country	England
Document type	Journal Article
ZDB-ID	2514982-9
ISSN	1759-8486 ; 1759-8478
ISSN (online)	1759-8486
ISSN	1759-8478
DOI	10.1136/neurintsurg-2017-013580
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