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Article ; Online: Editorial. FIAT, flow diverters, and establishing the role of new technology.

Amenta, Peter S / Medel, Ricky / Dumont, Aaron S

2016 Volume 127, Issue 3, Page(s) 449–453

MeSH term(s)	Aneurysm ; Humans ; Registries
Language	English
Publishing date	2016-11-04
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	3089-2
ISSN	1933-0693 ; 0022-3085
ISSN (online)	1933-0693
ISSN	0022-3085
DOI	10.3171/2016.5.JNS161096
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Article ; Online: Elucidating Sex Differences in Cerebral Aneurysm Biology and Therapy: The Time Is Now.

Amenta, Peter S / Medel, Ricky / Pascale, Crissey L / Dumont, Aaron S

Hypertension (Dallas, Tex. : 1979)

2016 Volume 68, Issue 2, Page(s) 312–314

Language	English
Publishing date	2016-08
Publishing country	United States
Document type	Editorial
ZDB-ID	423736-5
ISSN	1524-4563 ; 0194-911X ; 0362-4323
ISSN (online)	1524-4563
ISSN	0194-911X ; 0362-4323
DOI	10.1161/HYPERTENSIONAHA.116.07606
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Article ; Online: Inflammatory mediators in vascular disease: identifying promising targets for intracranial aneurysm research.

Sawyer, David M / Amenta, Peter S / Medel, Ricky / Dumont, Aaron S

Mediators of inflammation

2015 Volume 2015, Page(s) 896283

Abstract: Inflammatory processes are implicated in many diseases of the vasculature and have been shown to play a key role in the formation of intracranial aneurysms (IAs). Although the specific mechanisms underlying these processes have been thoroughly ... ...

Abstract	Inflammatory processes are implicated in many diseases of the vasculature and have been shown to play a key role in the formation of intracranial aneurysms (IAs). Although the specific mechanisms underlying these processes have been thoroughly investigated in related pathologies, such as atherosclerosis, there remains a paucity of information regarding the immunopathology of IA. Cells such as macrophages and lymphocytes and their effector molecules have been suggested to be players in IA, but their specific interactions and the role of other components of the inflammatory response have yet to be determined. Drawing parallels between the pathogenesis of IA and other vascular disorders could provide a roadmap for developing a mechanistic understanding of the immunopathology of IA and uncovering useful targets for therapeutic intervention. Future research should address the presence and function of leukocyte subsets, mechanisms of leukocyte recruitment and activation, and the role of damage-associated molecular patterns in IA.
MeSH term(s)	Animals ; Anti-Inflammatory Agents/pharmacology ; Antigen-Presenting Cells/cytology ; B-Lymphocytes/cytology ; Dendritic Cells/cytology ; Extracellular Matrix/metabolism ; Humans ; Inflammation/immunology ; Inflammation Mediators/physiology ; Intracranial Aneurysm/immunology ; Intracranial Aneurysm/therapy ; Lymphocytes/immunology ; Macrophages/cytology ; Macrophages/immunology ; Macrophages/metabolism ; Mice ; Risk Factors ; Signal Transduction ; Vascular Diseases/immunology
Chemical Substances	Anti-Inflammatory Agents ; Inflammation Mediators
Language	English
Publishing date	2015
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1137605-3
ISSN	1466-1861 ; 0962-9351
ISSN (online)	1466-1861
ISSN	0962-9351
DOI	10.1155/2015/896283
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Article ; Online: Inflammatory Mediators in Vascular Disease

David M. Sawyer / Peter S. Amenta / Ricky Medel / Aaron S. Dumont

Mediators of Inflammation, Vol

Identifying Promising Targets for Intracranial Aneurysm Research

2015 Volume 2015

Keywords	Pathology ; RB1-214 ; Medicine ; R
Language	English
Publishing date	2015-01-01T00:00:00Z
Publisher	Hindawi Publishing Corporation
Document type	Article ; Online
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Article ; Online: Endovascular Management of a Ruptured Basilar Perforator Artery Aneurysm Associated with a Pontine Arteriovenous Malformation: Case Report and Review of the Literature.

Lockwood, Joseph / Scullen, Tyler / Mathkour, Mansour / Kaufmann, Ascher / Medel, Ricky / Dumont, Aaron S / Amenta, Peter S

World neurosurgery

2018 Volume 116, Page(s) 159–162

Abstract: Background: Arteriovenous malformation (AVM)-associated aneurysms are common, reported in 15% of cases. Regarding the ruptured posterior fossa AVMs, associated aneurysms are present in 48% of cases and are the cause of the bleed in 37%. We present a 75- ... ...

Abstract	Background: Arteriovenous malformation (AVM)-associated aneurysms are common, reported in 15% of cases. Regarding the ruptured posterior fossa AVMs, associated aneurysms are present in 48% of cases and are the cause of the bleed in 37%. We present a 75-year-old female who presented with a subarachnoid hemorrhage secondary to a ruptured aneurysm arising from a flow-related basilar perforator artery feeder of an anterior pontine AVM. We report the successful treatment of the aneurysm with coil embolization. Case description: A 75-year-old female presented with subarachnoid hemorrhage primarily contained within the posterior fossa. Angiography demonstrated a 2 × 3-mm fusiform aneurysm arising from a basilar perforator feeding pedicle of an anterior 1 × 2-cm pontine AVM. Venous drainage from the AVM was predominantly to the superior petrosal vein. Under roadmap guidance, super-selective catheterization of the basilar perforator aneurysm was performed. Three HydroSoft 3D coils were deployed within the aneurysm, resulting in complete obliteration. The patient was discharged on postbleed day 15 to an inpatient rehabilitation facility. Follow-up angiography at 5 months demonstrated stable complete obliteration. The patient made a complete recovery and was living independently at the time of this report. Conclusions: Basilar trunk perforator aneurysms are rare lesions, particularly in the setting of brainstem AVMs. We report successful endovascular treatment of a flow-related ruptured basilar perforator aneurysm associated with an anterior pontine AVM. To the best of our knowledge, this is the second report addressing this scenario. We hope that the information presented here serves to guide future surgical decision making and management.
MeSH term(s)	Aged ; Aneurysm, Ruptured/complications ; Aneurysm, Ruptured/diagnostic imaging ; Aneurysm, Ruptured/therapy ; Arteriovenous Fistula/complications ; Arteriovenous Fistula/diagnostic imaging ; Arteriovenous Fistula/therapy ; Disease Management ; Embolization, Therapeutic/methods ; Endovascular Procedures/methods ; Female ; Humans ; Intracranial Aneurysm/complications ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/therapy ; Intracranial Arteriovenous Malformations/complications ; Intracranial Arteriovenous Malformations/diagnostic imaging ; Intracranial Arteriovenous Malformations/therapy ; Pons/diagnostic imaging
Language	English
Publishing date	2018-05-16
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2018.05.051
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Article: External lumbar drain: A pragmatic test for prediction of shunt outcomes in idiopathic normal pressure hydrocephalus.

Chotai, Silky / Medel, Ricky / Herial, Nabeel A / Medhkour, Azedine

Surgical neurology international

2014 Volume 5, Page(s) 12

Abstract: Background: The consensus on most reliable supplemental test to predict the shunt responsiveness in patients with idiopathic normal pressure hydrocephalus (iNPH) is lacking. The aim of this study is to discuss the utility of external lumbar drain (ELD) ... ...

Abstract	Background: The consensus on most reliable supplemental test to predict the shunt responsiveness in patients with idiopathic normal pressure hydrocephalus (iNPH) is lacking. The aim of this study is to discuss the utility of external lumbar drain (ELD) in evaluation of shunt responsiveness for iNPH patients. Methods: A retrospective review of 66 patients with iNPH was conducted. All patients underwent 4-day ELD trial. ELD-positive patients were offered ventriculoperitoneal shunt (VPS) surgery. The primary outcome evaluation parameters were gait and mini mental status examination (MMSE) assessment. The family and patient perception of improvement was accounted for in the outcome evaluation. Results: There were 38 male and 28 female with mean age of 74 years (range 45-88 years). ELD trial was positive in 86% (57/66) of patients. No major complications were encountered with the ELD trial. A total of 60 patients (57 ELD-positive, 3 ELD-negative) underwent VPS insertion. The negative ELD trial (P = 0.006) was associated with poor outcomes following shunt insertion. The positive ELD trial predicted shunt responsiveness in 96% patients (P < 0.0001, OR = 96.2, CI = 11.6-795.3). A receiver operating characteristic (ROC) curve analysis revealed that the ELD trial is reasonably accurate in differentiating shunt responder from non-responder in iNPH patients (area under curve = 0.8 ± 0.14, P = 0.02, CI = 0.52-1.0). The mean follow-up period was 12-months (range 0.3-3 years). The significant overall improvement after VPS was seen in 92% (55/60). The improvement was sustained in 76% of patients at mean 3-year follow-up. The number of comorbid conditions (P = 0.034, OR = 4.15, CI = 1.2-9.04), and a history of cerebrovascular accident (CVA) (P = 0.035, OR = 4.4, CI = 1.9-14.6) were the predictors of poor outcome following shunt surgery. Conclusion: The positive ELD test predicted shunt responsiveness in 96% of patients. With adequate technique, maximal results with minimal complications can be anticipated. The number of comorbidities, history of CVA and negative ELD test were significantly associated with poor shunt outcomes.
Language	English
Publishing date	2014-01-27
Publishing country	United States
Document type	Journal Article
ISSN	2229-5097
ISSN	2229-5097
DOI	10.4103/2152-7806.125860
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Article ; Online: Endovascular Management of Multiple Dysplastic Aneurysms in a Young Man with an Unknown Underlying Cause: A Case Report and Review of the Literature.

Scullen, Tyler / Mathkour, Mansour / Lockwood, Joseph / Ott, Leah / Medel, Ricky / Dumont, Aaron S / Amenta, Peter S

World neurosurgery

2018 Volume 111, Page(s) 349–357

Abstract: Background: Intracranial aneurysms are the leading cause of nontraumatic subarachnoid hemorrhage and are most commonly associated with the anterior cerebral artery (ACA) and anterior communicating artery complex. We describe the presentation and ... ...

Abstract	Background: Intracranial aneurysms are the leading cause of nontraumatic subarachnoid hemorrhage and are most commonly associated with the anterior cerebral artery (ACA) and anterior communicating artery complex. We describe the presentation and management of a 27-year-old man with concurrent bilateral A1-2 junction aneurysms and fusiform intraorbital ophthalmic artery (OA) aneurysms. Case description: A 27-year-old man with no past medical history presented with 3 months of headaches. Imaging showed a large dysplastic left A1-2 junction aneurysm and a smaller saccular right A1-2 junction aneurysm, with potentially adherent domes. Two fusiform aneurysms of the intraorbital segment of the left OA were also identified. The patient underwent coil-assisted pipeline embolization of the left A1-A2 aneurysm, with complete obliteration and reconstitution of the normal parent vessel. The patient underwent coil embolization of the right A1-2 aneurysm 3 weeks later, which was found to have grown significantly at the time of treatment. Three-month follow-up showed spontaneous resolution of the OA aneurysms, persistent obliteration of the left aneurysm, and significant recurrence of the right aneurysm, which was treated with stent-assisted coil embolization. A second recurrence 3 months later was successfully treated with repeat coiling. At the time of this treatment, the patient was also found to have 2 de novo distal middle cerebral artery and ACA dysplastic aneurysms, which were not treated. Follow-up angiography 6 weeks later showed stable complete obliteration of the right A1-2 aneurysm and interval complete resolution of the dysplastic middle cerebral artery aneurysm. The distal ACA aneurysm was observed to have minimally increased in size; however, the parent vessel showed signs of interval partial thrombosis with contrast stasis within the aneurysm. This final aneurysm is being followed with serial imaging. The patient remains neurologically intact with complete resolution of his headaches. Conclusions: We report the case of a young man with no past medical history who presented with multiple dysplastic aneurysms. Successful staged endovascular intervention resulted in obliteration of aneurysms with spontaneous obliteration of the intraorbital OA aneurysms observed at 3 months. We present this case to review the multiple challenges of managing complex ACA aneurysms and to highlight the usefulness of endovascular intervention in their treatment.
MeSH term(s)	Adult ; Cerebral Arteries/abnormalities ; Cerebral Arteries/diagnostic imaging ; Cerebral Arteries/surgery ; Endovascular Procedures ; Headache/diagnostic imaging ; Headache/etiology ; Headache/surgery ; Humans ; Intracranial Aneurysm/complications ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/drug therapy ; Intracranial Aneurysm/surgery ; Male
Language	English
Publishing date	2018-03
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2017.12.129
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: External lumbar drain

Silky Chotai / Ricky Medel / Nabeel A Herial / Azedine Medhkour

Surgical Neurology International, Vol 5, Iss 1, Pp 12-

A pragmatic test for prediction of shunt outcomes in idiopathic normal pressure hydrocephalus

2014 Volume 12

Abstract	Background: The consensus on most reliable supplemental test to predict the shunt responsiveness in patients with idiopathic normal pressure hydrocephalus (iNPH) is lacking. The aim of this study is to discuss the utility of external lumbar drain (ELD) in evaluation of shunt responsiveness for iNPH patients. Methods: A retrospective review of 66 patients with iNPH was conducted. All patients underwent 4-day ELD trial. ELD-positive patients were offered ventriculoperitoneal shunt (VPS) surgery. The primary outcome evaluation parameters were gait and mini mental status examination (MMSE) assessment. The family and patient perception of improvement was accounted for in the outcome evaluation. Results: There were 38 male and 28 female with mean age of 74 years (range 45-88 years). ELD trial was positive in 86% (57/66) of patients. No major complications were encountered with the ELD trial. A total of 60 patients (57 ELD-positive, 3 ELD-negative) underwent VPS insertion. The negative ELD trial (P = 0.006) was associated with poor outcomes following shunt insertion. The positive ELD trial predicted shunt responsiveness in 96% patients (P < 0.0001, OR = 96.2, CI = 11.6-795.3). A receiver operating characteristic (ROC) curve analysis revealed that the ELD trial is reasonably accurate in differentiating shunt responder from non-responder in iNPH patients (area under curve = 0.8 ± 0.14, P = 0.02, CI = 0.52-1.0). The mean follow-up period was 12-months (range 0.3-3 years). The significant overall improvement after VPS was seen in 92% (55/60). The improvement was sustained in 76% of patients at mean 3-year follow-up. The number of comorbid conditions (P = 0.034, OR = 4.15, CI = 1.2-9.04), and a history of cerebrovascular accident (CVA) (P = 0.035, OR = 4.4, CI = 1.9-14.6) were the predictors of poor outcome following shunt surgery. Conclusion: The positive ELD test predicted shunt responsiveness in 96% of patients. With adequate technique, maximal results with minimal complications can be anticipated. The number of comorbidities, history of CVA and negative ELD test were significantly associated with poor shunt outcomes.
Keywords	CSF tap test ; external lumbar drain ; idiopathic normal pressure hydrocephalus ; supplemental test ; valve pressure ; ventriculoperitoneal shunt ; Medicine ; R ; Surgery ; RD1-811 ; Internal medicine ; RC31-1245 ; Neurosciences. Biological psychiatry. Neuropsychiatry ; RC321-571 ; Neurology. Diseases of the nervous system ; RC346-429
Subject code	616
Publishing date	2014-01-01T00:00:00Z
Publisher	Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Advances in neurovascular treatments.

Starke, Robert M / Monteith, Stephen J / Chalouhi, Nohra / Ding, Dale / Medel, Ricky / Hasan, David / Dumont, Aaron S

BioMed research international

2014 Volume 2014, Page(s) 641539

MeSH term(s)	Animals ; Cerebrovascular Disorders/therapy ; Clinical Trials as Topic ; Female ; Humans ; Male ; Treatment Outcome
Language	English
Publishing date	2014-06-05
Publishing country	United States
Document type	Editorial ; Introductory Journal Article
ZDB-ID	2698540-8
ISSN	2314-6141 ; 2314-6133
ISSN (online)	2314-6141
ISSN	2314-6133
DOI	10.1155/2014/641539
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Article ; Online: Advances in Neurovascular Treatments

Robert M. Starke / Stephen J. Monteith / Nohra Chalouhi / Dale Ding / Ricky Medel / David Hasan / Aaron S. Dumont

BioMed Research International, Vol

2014 Volume 2014

Keywords	Medicine ; R
Language	English
Publishing date	2014-01-01T00:00:00Z
Publisher	Hindawi Publishing Corporation
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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