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  1. Article: Concurrent Carotid Endarterectomy and Flow Diverting for Supraclinoid Artery Aneurysm.

    Kiwan, Ruba / Jukes, Alistair / Johnston, Burnett / Boulton, Melfort

    The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques

    2021  Volume 49, Issue 1, Page(s) 146–148

    MeSH term(s) Arteries ; Carotid Artery Diseases/complications ; Carotid Artery Diseases/diagnostic imaging ; Carotid Artery Diseases/surgery ; Carotid Artery, Internal/diagnostic imaging ; Carotid Artery, Internal/surgery ; Endarterectomy, Carotid ; Humans ; Intracranial Aneurysm/complications ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/surgery
    Language English
    Publishing date 2021-03-26
    Publishing country England
    Document type Journal Article
    ZDB-ID 197622-9
    ISSN 0317-1671
    ISSN 0317-1671
    DOI 10.1017/cjn.2021.48
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    Zs.A 1203: Show issues Location:
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  2. Article ; Online: Rapid Recovery from Paraplegia in a Patient with Foix-Alajouanine Syndrome.

    Joswig, Holger / Haji, Faizal A / Martinez-Perez, Rafael / Steven, David A / Boulton, Melfort R

    World neurosurgery

    2017  Volume 97, Page(s) 750.e1–750.e3

    Abstract: Background: Foix-Alajouanine syndrome is defined as acute neurologic deterioration in the setting of a spinal dural arteriovenous fistula.: Case description: This case report on a young patient with an unusual clinical onset of Foix-Alajouanine ... ...

    Abstract Background: Foix-Alajouanine syndrome is defined as acute neurologic deterioration in the setting of a spinal dural arteriovenous fistula.
    Case description: This case report on a young patient with an unusual clinical onset of Foix-Alajouanine syndrome coincidentally occurring after his outpatient clinic appointment illustrates how prompt surgical treatment can result in rapid recovery of neurologic function despite preoperative paraplegia.
    Conclusions: Venous hypertension with subsequent rapid resolution after surgical treatment is the pathophysiological mechanism underlying a dural arteriovenous fistula, in contrast to historical views suggesting that these lesions result from irreversible venous thrombosis, resulting in necrotic myelopathy.
    MeSH term(s) Adult ; Central Nervous System Vascular Malformations/diagnosis ; Central Nervous System Vascular Malformations/surgery ; Diagnosis, Differential ; Humans ; Male ; Neurosurgical Procedures/methods ; Paraplegia/diagnostic imaging ; Paraplegia/prevention & control ; Spinal Cord Diseases/diagnosis ; Spinal Cord Diseases/surgery ; Syndrome
    Language English
    Publishing date 2017-01
    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.2016.10.101
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    Zs.A 1159: Show issues Location:
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  3. Article ; Online: High-Risk Factors in Symptomatic Patients Undergoing Carotid Artery Stenting With Distal Protection: Buffalo Risk Assessment Scale (BRASS).

    Lownie, Stephen P / Pelz, David M / Sharma, Manas / Pandey, Sachin K / Boulton, Melfort R / Lee, Donald H

    Neurosurgery

    2016  

    Language English
    Publishing date 2016-07-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 135446-2
    ISSN 1524-4040 ; 0148-396X
    ISSN (online) 1524-4040
    ISSN 0148-396X
    DOI 10.1227/NEU.0000000000001368
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    Zs.A 1424: Show issues Location:
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  4. Article ; Online: Plaque morphology (the PLAC Scale) on CT angiography: predicting long-term anatomical success of primary carotid stenting.

    Pelz, David M / Lownie, Stephen P / Lee, Donald H / Boulton, Melfort R

    Journal of neurosurgery

    2015  Volume 123, Issue 4, Page(s) 856–861

    Abstract: Object: Carotid angioplasty and stenting has emerged as an alternative to carotid endarterectomy for the treatment of atherosclerotic carotid stenosis. Primary carotid stenting, performed using self-expanding stents alone without deliberate use of ... ...

    Abstract Object: Carotid angioplasty and stenting has emerged as an alternative to carotid endarterectomy for the treatment of atherosclerotic carotid stenosis. Primary carotid stenting, performed using self-expanding stents alone without deliberate use of embolic protection devices and balloon angioplasty, has been shown to be effective and faster, cheaper, and potentially safer than conventional techniques. However, the long-term morphological results of this technique have not been established. The aim of this study was to determine whether preprocedural carotid plaque imaging at the site of maximal stenosis by using CT angiography (CTA) could predict the long-term morphological outcome of primary carotid stenting.
    Methods: One hundred eighty-one patients were treated over an 11-year period. Preprocedural CTA was performed in 102 of these. A morphological scale (the Predicting Long-term outcome with Angioplasty of the Carotid artery [PLAC] Scale), with grades from 0 to 4 and A or B, was used to evaluate the circumferential degree of plaque calcification, and the presence or absence of soft plaque. All patients were followed using duplex carotid ultrasound and plain radiographs. Satisfactory morphological outcome was defined as a peak systolic velocity < 120 cm/s and internal carotid artery/common carotid artery ratio < 1.4.
    Results: The average follow-up duration was 29.7 months (median 24.5 months, range 0.3-87 months). Univariate logistic regression demonstrated that a low calcification grade (p < 0.001), less thick calcification (p < 0.001), and moderate amounts of soft plaque (p < 0.001) are factors that are highly associated with good long-term outcome. Multivariate analyses confirmed that these factors are independent of each other in predicting outcome.
    Conclusions: The long-term morphological outcome of primary carotid stenting was predicted with considerable accuracy by using a straightforward CTA carotid plaque grading scale.
    MeSH term(s) Aged ; Aged, 80 and over ; Angiography/methods ; Carotid Stenosis/diagnostic imaging ; Carotid Stenosis/pathology ; Carotid Stenosis/surgery ; Humans ; Middle Aged ; Prognosis ; Remission Induction ; Retrospective Studies ; Stents ; Time Factors ; Tomography, X-Ray Computed
    Language English
    Publishing date 2015-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3089-2
    ISSN 1933-0693 ; 0022-3085
    ISSN (online) 1933-0693
    ISSN 0022-3085
    DOI 10.3171/2014.9.JNS14811
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  5. Article: Ruptured intracranial infectious aneurysms: Single Canadian center experience.

    Kiwan, Ruba / Son, Maksim / Mayich, Michael / Boulton, Melfort / Pandey, Sachin / Sharma, Manas

    Surgical neurology international

    2022  Volume 13, Page(s) 185

    Abstract: Background: Ruptured intracranial infected aneurysms (IIAs) are relatively rare, but they portend high mortality. To the best of our knowledge, there is no Canadian case series on IIA, as well there is a relative paucity of international published ... ...

    Abstract Background: Ruptured intracranial infected aneurysms (IIAs) are relatively rare, but they portend high mortality. To the best of our knowledge, there is no Canadian case series on IIA, as well there is a relative paucity of international published experiences. Our purpose is to share the experience of a single Canadian tertiary center in managing ruptured IIA and to conduct a systematic review.
    Methods: We did a retrospective case review series of adult patients with ruptured IIA treated at our institution. Second, we conducted a systematic review of the literature on ruptured IIA between 2011 and 2021 inclusive.
    Results: At our institution, of a total eight cases with ruptured IIA, four were treated endovascularly and two by surgical bypass. For the systematic review, we included nine noncomparative studies with a total of 509 patients (318 males) and at least 437 ruptured IIA aneurysms. Favorable outcome was specified for 63.3% of patients (
    Conclusion: This study highlights a single Canadian tertiary center experience in the management of IIA and compares it to the global trends of the past 10 years in a systematic review.
    Language English
    Publishing date 2022-05-06
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2229-5097
    ISSN 2229-5097
    DOI 10.25259/SNI_69_2022
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  6. Article ; Online: Letter: High-Risk Factors in Symptomatic Patients Undergoing Carotid Artery Stenting With Distal Protection: Buffalo Risk Assessment Scale (BRASS).

    Lownie, Stephen P / Pelz, David M / Sharma, Manas / Pandey, Sachin K / Boulton, Melfort R / Lee, Donald H

    Neurosurgery

    2016  Volume 79, Issue 5, Page(s) E639–E640

    MeSH term(s) Carotid Arteries ; Humans ; Risk Assessment ; Risk Factors ; Stents
    Language English
    Publishing date 2016-10-14
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 135446-2
    ISSN 1524-4040 ; 0148-396X
    ISSN (online) 1524-4040
    ISSN 0148-396X
    DOI 10.1227/NEU.0000000000001368
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    Zs.A 1424: Show issues Location:
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  7. Article ; Online: Blister-like supraclinoid internal carotid artery pseudoaneurysm in a 15-year-old male: case report and review of the literature.

    Haji, Faizal Aminmohamed / Boulton, Melfort R / de Ribaupierre, Sandrine

    Pediatric neurosurgery

    2011  Volume 47, Issue 6, Page(s) 449–454

    Abstract: With an incidence of less than 1-3 per million, pediatric aneurysms are rare clinical entities. A traumatic etiology is implicated in a large proportion of these cases, leading to the formation of both 'false' and 'true' aneurysms. These occur most often ...

    Abstract With an incidence of less than 1-3 per million, pediatric aneurysms are rare clinical entities. A traumatic etiology is implicated in a large proportion of these cases, leading to the formation of both 'false' and 'true' aneurysms. These occur most often in the distal circulation, but have also been described in the supraclinoid distal internal carotid artery (ICA). Blood blister aneurysms are also found in this location; however, they have not been described in the pediatric population. We report the case of a 15-year-old male who presented following cranial trauma with diffuse basal subarachnoid hemorrhage and limited additional intracranial pathology. Computed tomography angiography demonstrated a small, 2-mm blister-like aneurysm arising from the dorsal surface of the left supraclinoid ICA at a non-branching site. Despite early endovascular treatment with Guglielmi detachable coils, the lesion continued to grow over subsequent studies, necessitating open surgical clipping. At the time of surgery, gross pathology of the native ICA was observed, raising the possibility of a preexisting blood-blister aneurysm. We review the epidemiology, pathophysiology and diagnostic considerations of these lesions. The endovascular and surgical management of these complex non-branching supraclinoid ICA aneurysms is also discussed.
    MeSH term(s) Adolescent ; Carotid Artery Injuries/diagnostic imaging ; Carotid Artery Injuries/surgery ; Carotid Artery, Internal/diagnostic imaging ; Carotid Artery, Internal/surgery ; Humans ; Male ; Radiography ; Subarachnoid Hemorrhage, Traumatic/diagnostic imaging ; Subarachnoid Hemorrhage, Traumatic/surgery
    Language English
    Publishing date 2011
    Publishing country Switzerland
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 1091757-3
    ISSN 1423-0305 ; 1016-2291
    ISSN (online) 1423-0305
    ISSN 1016-2291
    DOI 10.1159/000339355
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  8. Article: Spinal Dural Arteriovenous Fistula with Unusual Tract Enhancement.

    Kiwan, Ruba / Wade, Kevin / Pandey, Sachin / Boulton, Melfort / Lee, Donald / Sharma, Manas

    The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques

    2021  Volume 48, Issue 6, Page(s) 857–858

    MeSH term(s) Central Nervous System Vascular Malformations/complications ; Central Nervous System Vascular Malformations/diagnostic imaging ; Humans ; Spinal Cord/diagnostic imaging ; Spine
    Language English
    Publishing date 2021-01-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 197622-9
    ISSN 0317-1671
    ISSN 0317-1671
    DOI 10.1017/cjn.2021.8
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  9. Article: A Protocol for Carotid Artery Stenting in COVID Times. A Single Canadian Centre Experience.

    Kiwan, Ruba / Jukes, Alistair / Mayich, Michael / Boulton, Melfort / Sharma, Manas / Pelz, David / Pandey, Sachin

    The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques

    2021  Volume 49, Issue 3, Page(s) 361–363

    Abstract: Objectives: The COVID-19 pandemic has resulted in huge disruption to healthcare delivery worldwide. There is a need to balance the urgent needs of the neurovascular patient population with the desire to preserve critical inpatient hospital capacity. It ... ...

    Abstract Objectives: The COVID-19 pandemic has resulted in huge disruption to healthcare delivery worldwide. There is a need to balance the urgent needs of the neurovascular patient population with the desire to preserve critical inpatient hospital capacity. It is incumbent on neurointerventionalists to advocate for their patients to minimise future disability. Patients still require semiurgent carotid revascularisation after ischaemic embolic events. We present a review of a novel protocol for expediting patient flow through the carotid stenting process, in accordance with government directives to minimise nonessential inpatient admissions, ensure its efficacy, and evaluate its safety. We also evaluate the literature regarding complications with attention to the timing of these related to the procedure.
    Methods: A retrospective review of 45 consecutive carotid stenting cases performed at London Health Sciences Centre between March 2020 and March 2021 for symptomatic extracranial internal carotid artery stenosis utilising a default same-day discharge policy was performed. Complications were plotted as a function of time.
    Results: Twenty-four patients underwent carotid artery stenting with same-day discharge and 21 patients underwent stenting with an overnight inpatient stay. A single stent occlusion occurred 27 h post stenting.
    Conclusion: Simple modification of protocol for symptomatic carotid artery stenting during the COVID-19 outbreak with radial access as first approach appears to provide safe, efficacious care.
    MeSH term(s) COVID-19 ; Canada ; Carotid Arteries ; Carotid Stenosis/complications ; Carotid Stenosis/surgery ; Humans ; Pandemics ; Retrospective Studies ; Review Literature as Topic ; Stents/adverse effects ; Stroke/etiology ; Treatment Outcome
    Language English
    Publishing date 2021-05-05
    Publishing country England
    Document type Journal Article
    ZDB-ID 197622-9
    ISSN 0317-1671
    ISSN 0317-1671
    DOI 10.1017/cjn.2021.105
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  10. Article ; Online: Foramen magnum meningiomas: concepts, classifications, and nuances.

    Boulton, Melfort R / Cusimano, Michael D

    Neurosurgical focus

    2003  Volume 14, Issue 6, Page(s) e10

    Abstract: Foramen magnum meningiomas represent a common histological tumor in a rare and eloquent location. The authors review the clinical presentation, relevant anatomical details of the foramen magnum region, neuroimaging features, the posterior and ... ...

    Abstract Foramen magnum meningiomas represent a common histological tumor in a rare and eloquent location. The authors review the clinical presentation, relevant anatomical details of the foramen magnum region, neuroimaging features, the posterior and posterolateral surgical approaches for resection, and outcomes. Based the experiences of the senior author (M.D.C.) and a review of the literature, they introduce the concept of a "surgical corridor," discuss the classification of these tumors, and the nuances of care for patients with these challenging lesions.
    MeSH term(s) Foramen Magnum/diagnostic imaging ; Foramen Magnum/surgery ; Humans ; Meningeal Neoplasms/classification ; Meningeal Neoplasms/diagnostic imaging ; Meningeal Neoplasms/surgery ; Meningioma/classification ; Meningioma/diagnostic imaging ; Meningioma/surgery ; Neurosurgical Procedures/methods ; Radiography
    Language English
    Publishing date 2003-06-15
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2026589-X
    ISSN 1092-0684 ; 1092-0684
    ISSN (online) 1092-0684
    ISSN 1092-0684
    DOI 10.3171/foc.2003.14.6.10
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