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Article: Development and design of low field compact intraoperative MRI for standard operating room.

Hadani, Moshe

2011 Volume 109, Page(s) 29–33

Abstract: Objectives: To present the development of a compact low field intraoperative MR image guidance system and its application in brain surgery.: Methods: The PoleStar ioMRI system (Odin Medical Technologies, Israel and Medtronic, Inc. USA) was developed ... ...

Abstract	Objectives: To present the development of a compact low field intraoperative MR image guidance system and its application in brain surgery. Methods: The PoleStar ioMRI system (Odin Medical Technologies, Israel and Medtronic, Inc. USA) was developed for use in a standard operating room. Its primary physical fixed parameters are magnetic field of 0.15 T and field of view of 20 x 16 cm. The magnet is mounted on a transportable gantry and can be positioned under the surgical table when not in use for scanning. Additional functionality includes integrated navigation, and system operation by the surgeons. Results: The PoleStar system integrates into existing operating rooms requiring only slight modification of the surgical environment. Standard instruments can be used. The system's imaging allows it to be used for the following indications: pituitary tumors, low grade gliomas (including awake surgery), high grade gliomas, intraventricular tumors, accurate navigation to small lesions such as cavernous angiomas or metastases, drainage of cysts and brain abscesses. The image quality, which is comparable to post operative diagnostic high field imaging, enables high quality resection control. More than 6,000 brain surgeries were done with the system in 50 centers in the US and Europe. Conclusion: The low field intraoperative MRI system is a valuable tool in the modern operating room.
MeSH term(s)	Brain Neoplasms/pathology ; Brain Neoplasms/surgery ; Humans ; Magnetic Resonance Imaging/instrumentation ; Magnetic Resonance Imaging/methods ; Monitoring, Intraoperative ; Neuronavigation/instrumentation ; Neuronavigation/methods ; Operating Rooms/standards
Language	English
Publishing date	2011
Publishing country	Austria
Document type	Journal Article
ISSN	0065-1419
ISSN	0065-1419
DOI	10.1007/978-3-211-99651-5_5
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Article ; Online: Antibody array strategy for human growth factor secretome profiling of GH-secreting adenomas.

Ozeri, Orly / Cohen, Zvi R / Hadani, Moshe / Nass, Dvora / Shimon, Ilan / Rubinfeld, Hadara

Pituitary

2019 Volume 22, Issue 4, Page(s) 344–352

Abstract: Purposes: To test if the antibody array strategy could be utilized to simultaneously detect the secretion of multiple growth factors by human pituitary GH-adenomas and to measure octreotide-induced alterations.: Methods: Specimens of human pituitary ... ...

Abstract	Purposes: To test if the antibody array strategy could be utilized to simultaneously detect the secretion of multiple growth factors by human pituitary GH-adenomas and to measure octreotide-induced alterations. Methods: Specimens of human pituitary adenomas were cultured and incubated with or without octreotide for 24 h. Conditional media were analyzed by human growth factor antibody array and VEGF concentrations were measured by ELISA. Media were also analyzed for GH concentrations. p21 expression levels were examined by Western blot of the specimens lysates. Results: The antibody arrays successfully identified growth factors secreted by GH-adenomas in vitro. Octreotide treatment induced both elevations and reductions in growth factors secretion. GH response to octreotide was measured, and in this small-sized study resistant and sensitive GH-adenomas presented with no unique secretome pattern of each of the groups. Octreotide-induced VEGF alterations analyzed by the antibody array and by ELISA were not fully matched. Conclusions: This study suggests that the broad proteomic strategy of antibody arrays may be utilized to study the growth factors secretion pattern of GH-adenomas and its regulation by somatostatin analogs or other compounds.
MeSH term(s)	Adenoma/metabolism ; Antibodies/metabolism ; Enzyme-Linked Immunosorbent Assay ; Gene Expression/drug effects ; Gene Expression/genetics ; Human Growth Hormone/metabolism ; Humans ; Octreotide/pharmacology ; Vascular Endothelial Growth Factor A/metabolism
Chemical Substances	Antibodies ; Vascular Endothelial Growth Factor A ; Human Growth Hormone (12629-01-5) ; Octreotide (RWM8CCW8GP)
Language	English
Publishing date	2019-03-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	1385151-2
ISSN	1573-7403 ; 1386-341X
ISSN (online)	1573-7403
ISSN	1386-341X
DOI	10.1007/s11102-019-00955-x
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Article: Utility of the Polestar N30 low-field MRI system for resecting non-enhancing intra-axial brain lesions.

Ungar, Lior / Zibly, Zion / Wohl, Anton / Harel, Ran / Hadani, Moshe / Attia, Moshe / Spiegelmann, Roberto / Feldman, Zeev / Zaubermann, Jacob / Knoller, Nachshon / Cohen, Zvi R

Neurologia i neurochirurgia polska

2021 Volume 55, Issue 2, Page(s) 202–211

Abstract: Background: To determine the utility of an intraoperative magnetic resonance imaging (iMRI) system, the Polestar N30, for enhancing the resection control of non-enhancing intra-axial brain lesions.: Materials and methods: Seventy-three patients (60 ... ...

Abstract	Background: To determine the utility of an intraoperative magnetic resonance imaging (iMRI) system, the Polestar N30, for enhancing the resection control of non-enhancing intra-axial brain lesions. Materials and methods: Seventy-three patients (60 males [83.3%], mean age 37 years) with intra-axial brain lesions underwent resection at Sheba Medical Centre using the Polestar between February 2012 and the end of August 2018. Demographic and imaging data were retrospectively analysed. Thirty-five patients had a non-enhancing lesion (48%). Results: Complete resection was planned for 60/73 cases after preoperative imaging. Complete resection was achieved in 59/60 (98.3%) cases. After iMRI, additional resection was performed in 24/73 (32.8%) cases, and complete resection was performed in 17/60 (28.8%) cases in which a complete resection was intended. In 6/13 (46%) patients for whom incomplete resection was intended, further resection was performed. The extent of resection was extended mainly for non-enhancing lesions: 16/35 (46%) as opposed to only 8/38 (21%) for enhancing lesions. Further resection was not significantly associated with sex, age, intended resection, recurrence, or affected side. Univariate analysis revealed non-eloquent area, intended complete resection, and enhancing lesions to be predictive factors for complete resection, and non-enhancing lesions and scan time to be predictive factors for an extended resection. Non-enhancement was the only independent factor for extended resection. Conclusions: The Polestar N30 is useful for evaluating residual non-enhancing intra-axial brain lesions and achieving maximal resection.
MeSH term(s)	Adult ; Brain/diagnostic imaging ; Brain/surgery ; Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/surgery ; Glioma ; Humans ; Magnetic Resonance Imaging ; Male ; Monitoring, Intraoperative ; Neoplasm Recurrence, Local ; Retrospective Studies
Language	English
Publishing date	2021-02-09
Publishing country	Poland
Document type	Journal Article
ZDB-ID	415519-1
ISSN	1897-4260 ; 0028-3843
ISSN (online)	1897-4260
ISSN	0028-3843
DOI	10.5603/PJNNS.a2021.0017
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Article: Simulation-based interpersonal communication skills training for neurosurgical residents.

Harnof, Sagi / Hadani, Moshe / Ziv, Amitai / Berkenstadt, Haim

The Israel Medical Association journal : IMAJ

2013 Volume 15, Issue 9, Page(s) 489–492

Abstract: Background: Communication skills are an important component of the neurosurgery residency training program. We developed a simulation-based training module for neurosurgery residents in which medical, communication and ethical dilemmas are presented by ... ...

Abstract	Background: Communication skills are an important component of the neurosurgery residency training program. We developed a simulation-based training module for neurosurgery residents in which medical, communication and ethical dilemmas are presented by role-playing actors. Objectives: To assess the first national simulation-based communication skills training for neurosurgical residents. Methods: Eight scenarios covering different aspects of neurosurgery were developed by our team: (1) obtaining informed consent for an elective surgery, (2) discharge of a patient following elective surgery, (3) dealing with an unsatisfied patient, (4) delivering news of intraoperative complications, (5) delivering news of a brain tumor to parents of a 5 year old boy, (6) delivering news of brain death to a family member, (7) obtaining informed consent for urgent surgery from the grandfather of a 7 year old boy with an epidural hematoma, and (8) dealing with a case of child abuse. Fifteen neurosurgery residents from all major medical centers in Israel participated in the training. The session was recorded on video and was followed by videotaped debriefing by a senior neurosurgeon and communication expert and by feedback questionnaires. Results: All trainees participated in two scenarios and observed another two. Participants largely agreed that the actors simulating patients represented real patients and family members and that the videotaped debriefing contributed to the teaching of professional skills. Conclusions: Simulation-based communication skill training is effective, and together with thorough debriefing is an excellent learning and practical method for imparting communication skills to neurosurgery residents. Such simulation-based training will ultimately be part of the national residency program.
MeSH term(s)	Clinical Competence ; Communication ; Ethics, Medical/education ; Humans ; Internship and Residency/standards ; Israel ; Neurosurgery/education ; Patient Simulation ; Surveys and Questionnaires ; Videotape Recording
Language	English
Publishing date	2013-09
Publishing country	Israel
Document type	Journal Article
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
ISSN	1565-1088 ; 0021-2180
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Article ; Online: Potential of magnetic resonance-guided focused ultrasound for intracranial hemorrhage: an in vitro feasibility study.

Harnof, Sagi / Hananel, Arik / Zilby, Zion / Kulbatski, Iris / Hadani, Moshe / Kassell, Neal

International journal of stroke : official journal of the International Stroke Society

2014 Volume 9, Issue 1, Page(s) 40–47

Abstract: Background: Intracranial hemorrhage has a mortality rate of up to 40-60% due to the lack of effective treatment. Magnetic resonance-guided focused ultrasound may offer a breakthrough noninvasive technology, by allowing accurate delivery of focused ... ...

Abstract	Background: Intracranial hemorrhage has a mortality rate of up to 40-60% due to the lack of effective treatment. Magnetic resonance-guided focused ultrasound may offer a breakthrough noninvasive technology, by allowing accurate delivery of focused ultrasound, under the guidance of real-time magnetic resonance imaging. Aim: The purpose of the current study was to optimize the acoustic parameters of magnetic resonance-guided focused ultrasound for effective clot liquefaction, in order to evaluate the feasibility of magnetic resonance-guided focused ultrasound for thrombolysis. Methods: Body (1·1 MHz) and brain (220 kHz) magnetic resonance-guided focused ultrasound systems (InSightec Ltd, Tirat Carmel, Israel) were used to treat tube-like (4 cc), round (10 cc), and bulk (300 cc) porcine blood clots in vitro, using burst sonications of one-second to five-seconds, a duty cycle of 5-50%, and peak acoustic powers between 600 and 1200 W. Liquefied volumes were measured as hyperintense regions on T2-weighted magnetic resonance images for body unit sonications (duration of one-second, duty cycle of 10%, and power of 500-1200 W). Liquefaction efficiency was calculated for brain unit sonications (duration of one-second, duty cycle of 10%, power of 600 W, and burst length between 0·1 ms and 100 ms). Results: Liquified lesion volume increased as power was raised, without a thermal rise. For brain unit sonications, a power setting of 600 W and ultrashort sonications (burst length between 0·1 and 1·0 ms) resulted in liquefaction efficacy above 50%, while longer burst duration yielded lower efficacy. Conclusions: These results demonstrate the feasibility of obtaining reproducible, rapid, efficient, and accurate blood clot lysis using the magnetic resonance-guided focused ultrasound system. Further in vivo studies are needed to validate the feasibility of magnetic resonance-guided focused ultrasound as a treatment modality for intracranial hemorrhage.
MeSH term(s)	Animals ; Feasibility Studies ; Intracranial Hemorrhages/diagnostic imaging ; Magnetic Resonance Imaging/methods ; Mechanical Thrombolysis/methods ; Surgery, Computer-Assisted/methods ; Swine ; Ultrasonography
Language	English
Publishing date	2014-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2303728-3
ISSN	1747-4949 ; 1747-4930
ISSN (online)	1747-4949
ISSN	1747-4930
DOI	10.1111/ijs.12051
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Article ; Online: Sonoablation and application of MRI guided focused ultrasound in a preclinical model.

Zibly, Zion / Graves, Christian A / Harnof, Sagi / Hadani, Moshe / Cohen, Zvi R

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

2014 Volume 21, Issue 10, Page(s) 1808–1814

Abstract: Stereotaxic sonoablative surgery by MRI guided high intensity focused ultrasound (FUS) holds great potential in disorders of the central nervous system (CNS). We previously described the ExAblate 2000 system (InSightec, Tirat Carmel, Israel), currently ... ...

Abstract	Stereotaxic sonoablative surgery by MRI guided high intensity focused ultrasound (FUS) holds great potential in disorders of the central nervous system (CNS). We previously described the ExAblate 2000 system (InSightec, Tirat Carmel, Israel), currently in use for various pathologies including uterine, liver, and, breast tumors, and referred to as the "body" system. Using a porcine model we have previously demonstrated, using the body system, the ablative capacity and thermal transfer in the cortex; developed a reproducible and translational model of craniectomy and post-operative recovery in FUS; and determined a grouping strategy based on thermal ablation and pathologic incremental changes in the cortex. Here we describe a novel ExAblate 4000 system that is designed specifically to treat CNS disorders ("head" system). Twenty-two swine underwent an improved wide craniectomy for positioning of the ExAblate 4000 containing 1024 elements arrayed with MRI guidance. Further neurologic and pathological analysis was performed 1 week post-operatively. Subjects underwent a wide craniectomy followed by high intensity MR guided focused ultrasound (MRgHIFU) sonoablation. Thermal ultrasonic ablative lesions were achieved in all subjects (n=22) ranging from 52-65°C following ∼70 consecutive sonications at 80 watts. These subjects were grouped based on thermal ablative lesions and post-operative staging (MRI, gross and microscopic pathology). Our results indicate the reproducibility of a porcine model for cerebral ablation, achieved across a dynamic temperature range, and well tolerated in this cohort. The ExAblate 4000 system is efficient through a wide craniectomy as well as a closed skull and demonstrates a high safety margin. Incremental hemorrhage and necrosis were minimal and energy dependent, indicating MRgHIFU can be used for the treatment of various cerebral pathologies and movement disorders.
MeSH term(s)	Animals ; Brain/pathology ; Brain/physiopathology ; Brain/surgery ; Craniotomy ; Female ; High-Intensity Focused Ultrasound Ablation/instrumentation ; High-Intensity Focused Ultrasound Ablation/methods ; Magnetic Resonance Imaging/methods ; Models, Animal ; Reproducibility of Results ; Surgery, Computer-Assisted/methods ; Swine ; Temperature
Language	English
Publishing date	2014-10
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	1193674-5
ISSN	1532-2653 ; 0967-5868
ISSN (online)	1532-2653
ISSN	0967-5868
DOI	10.1016/j.jocn.2014.04.008
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Article ; Online: Intraoperative magnetic resonance imaging for resection of intra-axial brain lesions: a decade of experience using low-field magnetic resonance imaging, Polestar N-10, 20, 30 systems.

Livne, Ofir / Harel, Ran / Hadani, Moshe / Spiegelmann, Roberto / Feldman, Zeev / Cohen, Zvi R

World neurosurgery

2014 Volume 82, Issue 5, Page(s) 770–776

Abstract: Objective: The aim of this study was to determine the utility of an intraoperative magnetic resonance imaging (i-MRI) system (Polestar N-10, 20, 30) in achieving maximal resection of intra-axial brain lesions.: Methods: The subjects comprised 163 ... ...

Abstract	Objective: The aim of this study was to determine the utility of an intraoperative magnetic resonance imaging (i-MRI) system (Polestar N-10, 20, 30) in achieving maximal resection of intra-axial brain lesions. Methods: The subjects comprised 163 patients with intra-axial brain lesions who underwent resection at Sheba Medical Center using the Polestar from February 2000 through February 2012. Demographic and imaging data were obtained and analyzed retrospectively. The patients included 83 men (50.9%) and had a mean age of 43 years. High-grade gliomas were diagnosed in 72 patients, low-grade gliomas in 35, metastases in 22, and various pathologies (e.g., cavernous angiomas, juvenile pilocytic astrocytoma, pleomorphic xanthoastrocytoma, etc.) were diagnosed in 34. The majority of the lesions (84, 51.5%) were located in or near eloquent areas. Fifty-one patients had nonenhancing lesions. Results: We intended to achieve complete resection in 110 of 163 cases, based on preoperative imaging. Complete resection was achieved in 90 of these 110 (81.8%) cases. Intraoperative MRI led to additional resection in 42.3% of the total cases and to complete resection in 43.3% of all the cases in which a complete resection was achieved. In 76.8% of these cases, 2 intraoperative scans were sufficient to achieve complete resection. Sex, age, intent of resection, recurrence, affected side, and radiologic characteristics did not differ significantly between cases in which intraoperative MRI led to further resection and cases in which it did not. Nonenhancing lesions of all types were 3 times more likely to require additional resection after obtaining intraoperative MRIs (P = .02). Conclusions: The Polestar (N-10, 20, 30) proved useful for evaluating residual intra-axial brain lesions and achieving the maximal extent of resection in 42.3% of the total cases and in 43.3% of cases in which complete resection was achieved. Intraoperative MRI led to extended resection in 46.9% of patients for whom the initial intent was to perform an incomplete resection. Nonenhancement was the only independent variable predicting the usefulness of intraoperative MRI for additional lesion resection.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Astrocytoma/pathology ; Astrocytoma/surgery ; Brain Neoplasms/pathology ; Brain Neoplasms/surgery ; Child ; Child, Preschool ; Female ; Glioma/secondary ; Glioma/surgery ; Hemangioma, Cavernous, Central Nervous System/pathology ; Hemangioma, Cavernous, Central Nervous System/surgery ; Humans ; Magnetic Resonance Imaging/instrumentation ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Monitoring, Intraoperative/instrumentation ; Monitoring, Intraoperative/methods ; Neoplasm Grading ; Neurosurgical Procedures/methods ; Retrospective Studies ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2014-11
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.2014.02.004
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Zs.A 1159: Show issues

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Article ; Online: Combination of mTOR Inhibitors Augments Potency while Activating PI3K Signaling in Pituitary Tumors.

Rubinfeld, Hadara / Cohen, Ortal / Kammer, Adi / Yang, Guang / Cohen, Zvi R / Hadani, Moshe / Shimon, Ilan

Neuroendocrinology

2016 Volume 103, Issue 5, Page(s) 592–604

Abstract: Background: Despite the success in treating some cancers, the efficacy of the mTOR inhibitors rapalogs as anti-cancer therapeutics has been limited.: Aims: We undertook to examine the effects of Torin1, a second-generation selective ATP-competitive ... ...

Abstract	Background: Despite the success in treating some cancers, the efficacy of the mTOR inhibitors rapalogs as anti-cancer therapeutics has been limited. Aims: We undertook to examine the effects of Torin1, a second-generation selective ATP-competitive mTOR inhibitor, in non-functioning pituitary tumor cells. During characterization of the molecular mechanisms that mediate Torin1 actions, there seemed to be a rationale for combining it with rapalogs. Methods: Proliferation assays, flow cytometry and Western blotting were applied to assess the effects of Torin1, RAD001 and their combination on an MtT/E pituitary cell line and human-derived non-functioning pituitary tumor cells. Results: Combined long treatments of Torin1 and RAD001 induced a pronounced reduction in cell growth and viability of both MtT/E pituitary cells and human-derived non-functioning pituitary tumor cells, superior to each drug alone. This was remarkable in the 10 nM combination and was reflected in a triggered decrease of cyclin D3 and p21/CIP expression. Interestingly, Akt-Thr308 and SIN1-Thr86 phosphorylations were robustly elevated in the combined treatment, accompanied by a reduction in PTEN expression. Phosphorylation of p70S6K was abolished in all individual and combined treatments. Akt-Ser473 phosphorylation, induced by RAD001, was reduced by the combined treatment to the same extent as when treated by Torin1 alone. Conclusions: Our results suggest that the differential signaling mechanisms induced by these compounds eventually converge to lead to an efficient blockade of the PI3K/Akt/mTOR pathway in pituitary tumor cells and may facilitate a reduction in treatment dosage.
MeSH term(s)	Adolescent ; Adult ; Antineoplastic Agents/pharmacology ; Antineoplastic Combined Chemotherapy Protocols ; Cell Cycle/drug effects ; Cell Line, Tumor/drug effects ; Cell Survival/drug effects ; Female ; Gene Expression Regulation, Neoplastic/drug effects ; Humans ; Male ; Naphthyridines/pharmacology ; PTEN Phosphohydrolase/genetics ; PTEN Phosphohydrolase/metabolism ; Phosphatidylinositol 3-Kinases/genetics ; Phosphatidylinositol 3-Kinases/metabolism ; Phosphorylation/drug effects ; Pituitary Neoplasms/pathology ; RNA, Messenger/metabolism ; Signal Transduction/drug effects ; Young Adult
Chemical Substances	1-(4-(4-propionylpiperazin-1-yl)-3-(trifluoromethyl)phenyl)-9-(quinolin-3-yl)benzo(h)(1,6)naphthyridin-2(1H)-one ; Antineoplastic Agents ; Naphthyridines ; RNA, Messenger ; Phosphatidylinositol 3-Kinases (EC 2.7.1.-) ; PTEN Phosphohydrolase (EC 3.1.3.67)
Language	English
Publishing date	2016
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	123303-8
ISSN	1423-0194 ; 0028-3835
ISSN (online)	1423-0194
ISSN	0028-3835
DOI	10.1159/000442205
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Article ; Online: Modern intraoperative imaging modalities for the vascular neurosurgeon treating intracerebral hemorrhage.

Goren, Oded / Monteith, Stephen J / Hadani, Moshe / Bakon, Mati / Harnof, Sagi

Neurosurgical focus

2013 Volume 34, Issue 5, Page(s) E2

Abstract: This paper reviews the current intraoperative imaging tools that are available to assist neurosurgeons in the treatment of intracerebral hemorrhage (ICH). This review shares the authors' experience with each modality and discusses the advantages, ... ...

Abstract	This paper reviews the current intraoperative imaging tools that are available to assist neurosurgeons in the treatment of intracerebral hemorrhage (ICH). This review shares the authors' experience with each modality and discusses the advantages, potential limitations, and disadvantages of each. Surgery for ICH is directed at blood clot removal, reduction of intracranial pressure, and minimization of secondary damage associated with hematoma breakdown products. For effective occlusion and safe obliteration of vascular anomalies associated with ICH, vascular neurosurgeons today require a thorough understanding of the various intraoperative imaging modalities available for obtaining real-time information. Use of one or more of these modalities may improve the surgeon's confidence during the procedure, the patient's safety during surgery, and surgical outcome. The modern techniques discussed include 1) indocyanine green-based video angiography, which provides real-time information based on high-quality images showing the residual filling of vascular pathological entities and the patency of blood vessels of any size in the surgical field; and 2) intraoperative angiography, which remains the gold standard intraoperative diagnostic test in the surgical management of cerebral aneurysms and arteriovenous malformations. Hybrid procedures, providing multimodality image-guided surgeries and combining endovascular with microsurgical strategies within the same surgical session, have become feasible and safe. Microdoppler is a safe, noninvasive, and reliable technique for evaluation of hemodynamics of vessels in the surgical field, with the advantage of ease of use. Intraoperative MRI provides an effective navigation tool for cavernoma surgery, in addition to assessing the extent of resection during the procedure. Intraoperative CT scanning has the advantage of very high sensitivity to acute bleeding, thereby assisting in the confirmation of the extent of hematoma evacuation and the extent of vascular anomaly resection. Intraoperative ultrasound aids navigation and evacuation assessment during intracerebral hematoma evacuation surgeries. It supports the concept of minimally invasive surgery and has undergone extensive development in recent years, with the quality of ultrasound imaging having improved considerably. Image-guided therapy, combined with modern intraoperative imaging modalities, has changed the fundamentals of conventional vascular neurosurgery by presenting real-time visualization of both normal tissue and pathological entities. These imaging techniques are important adjuncts to the surgeon's standard surgical armamentarium. Familiarity with these imaging modalities may help the surgeon complete procedures with improved safety, efficiency, and clinical outcome.
MeSH term(s)	Cerebral Hemorrhage/surgery ; Humans ; Monitoring, Intraoperative ; Neurosurgery/methods ; Surgery, Computer-Assisted ; Vascular Surgical Procedures/methods
Language	English
Publishing date	2013-05
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	10.3171/2013.2.FOCUS1324
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Article ; Online: Description of the vasospasm phenomena following perimesencephalic nonaneurysmal subarachnoid hemorrhage.

Prat, Daphna / Goren, Oded / Bruk, Bela / Bakon, Mati / Hadani, Moshe / Harnof, Sagi

BioMed research international

2013 Volume 2013, Page(s) 371063

Abstract: Background: Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PM-NASAH) is characterized by a benign course compared with aneurysmal SAH. While vasospasm (VS) after aneurysmal SAH is considered responsible for serious complications, VS post-PM- ... ...

Abstract	Background: Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PM-NASAH) is characterized by a benign course compared with aneurysmal SAH. While vasospasm (VS) after aneurysmal SAH is considered responsible for serious complications, VS post-PM-NASAH is not well documented. Our purpose was to characterize the incidence and course of VS among 63 patients--one of the largest databases of PM-NASAH patients with documented blood flow velocities in the literature. Methods: Data from 63 patients that were admitted with PM-NASAH from 2000 to 2012 and underwent transcranial Doppler tests to assess cranial vessel flow velocity was analyzed. Results: On average, the maximal flow velocity was measured on the 7th day after hemorrhage. Higher risk for VS was associated with younger age, female sex, and higher Hunt and Hess scores, a lower risk for patients treated with statins (P < 0.05). Using velocity thresholds for diagnosis of VS, 49.2% showed evidence of VS. This is the first description of blood flow velocities in PM-NASAH. VS average onset was on the 4th day, average cessation on day 15 after hemorrhage. No patients showed clinical manifestation of VS. Conclusions: VS post-PM-NASAH is not as rare as previously believed. However, its lack of clinical significance raises questions regarding the need for diagnosis and may suggest a less intensive treatment protocol.
MeSH term(s)	Adult ; Aged ; Blood Flow Velocity ; Brain/blood supply ; Cerebrovascular Circulation ; Four-Dimensional Computed Tomography ; Humans ; Male ; Middle Aged ; Subarachnoid Hemorrhage/complications ; Subarachnoid Hemorrhage/diagnostic imaging ; Subarachnoid Hemorrhage/pathology ; Vasospasm, Intracranial/complications ; Vasospasm, Intracranial/diagnostic imaging ; Vasospasm, Intracranial/pathology
Language	English
Publishing date	2013-12-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2698540-8
ISSN	2314-6141 ; 2314-6133
ISSN (online)	2314-6141
ISSN	2314-6133
DOI	10.1155/2013/371063
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In stock of ZB MED Cologne/Königswinter

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