scholarly journals Flow diversion of tandem cerebral aneurysms: a multi-institutional retrospective study

2017 ◽  
Vol 42 (6) ◽  
pp. E10 ◽  
Author(s):  
Al-Wala Awad ◽  
Karam Moon ◽  
Nam Yoon ◽  
Marcus D. Mazur ◽  
M. Yashar S. Kalani ◽  
...  
Keyword(s):  
Salt Lake ◽  
Demographic Data ◽  
Salt Lake City ◽  
Cerebral Aneurysms ◽  
Flow Diversion ◽  
Single Session ◽  
Anterior Circulation ◽  
The Mean ◽  
Lake City

OBJECTIVEFlow diversion has proven to be an efficacious means of treating cerebral aneurysms that are refractory to other therapeutic means. Patients with tandem aneurysms treated with flow diversion have been included in larger, previously reported series; however, there are no dedicated reports on using this technique during a single session to treat this unique subset of patients. Therefore, the authors analyzed the outcomes of patients who had undergone single-session flow diversion for the treatment of tandem aneurysms.METHODSThe authors conducted a retrospective review of flow diversion with the Pipeline embolization device (PED) for the treatment of tandem aneurysms in a single session at 2 participating medical centers: University of Utah, Salt Lake City, Utah, and Barrow Neurological Institute, Phoenix, Arizona. Patient demographic data, aneurysm characteristics, treatment strategy and results, complications, and follow-up data were collected from the medical record and analyzed.RESULTSBetween January 2011 and December 2015, 17 patients (12 female, 5 male) with a total of 38 aneurysms (mean size 4.7 ± 2.7 mm, mean ± SD) were treated. Sixteen patients had aneurysms in the anterior circulation, and 1 patient had tandem aneurysms in the posterior circulation. Twelve patients underwent only placement of a PED, whereas 5 underwent adjunctive coil embolization of at least 1 aneurysm. One PED was used in each of 9 patients, and 2 PEDs were required in each of 8 patients. There were 2 intraprocedural complications; however, in both instances, the patients were asymptomatic at the last follow-up. The follow-up imaging studies were available for 15 patients at a mean of 7 months after treatment (216 days, range 0–540 days). The mean initial Raymond score after treatment was 2.7 ± 0.7, and the mean final score was 1.3 ± 0.7.CONCLUSIONSIn this series, the use of flow diversion for the treatment of tandem cerebral aneurysms had an acceptable safety profile, indicating that it should be considered as an effective therapy for this complicated subset of patients. Further prospective studies must be performed before more definitive conclusions can be made.

scholarly journals Early Posterior Vault Distraction Osteogenesis for the Treatment of Syndromic Craniosynostosis

2016 ◽  
Vol 9 (3) ◽  
pp. 219-223 ◽  
Author(s):  
Dana Johns ◽  
Erin Anstadt ◽  
Daniel Donato ◽  
John Kestle ◽  
Jay Riva-Cambrin ◽  
...  
Keyword(s):  
Salt Lake ◽  
Salt Lake City ◽  
Cerebrospinal Fluid Leak ◽  
Cranial Vault ◽  
Intracranial Volume ◽  
Syndromic Craniosynostosis ◽  
Time Period ◽  
Lake City ◽  
Fluid Leak

Posterior cranial vault distraction (PCVD) has become an important modality in the management of complex craniosynostosis to increase intracranial volume and improve the cranial vault appearance. This technique can safely be performed as early as 3 months of age for the initial management of patients with complex craniosynostosis. A retrospective review was performed of all the patients with syndromic, multiple-suture synostosis treated with PCVD at Primary Children's Hospital in Salt Lake City, Utah, between 2012 and 2014. During this time period, a total of nine children with an average corrected age of 21.4 weeks were treated. Demographics, intraoperative data, and postoperative distraction data were collected. Occipital frontal head circumferences (OFCs) were recorded pre- and postdistraction, and at 3- and 6-month follow-up examinations. All patients had a substantial increase in head circumference with subjective improvement of the posterior calvarium shape. The average increase in OFC from preoperative to postdistraction was 4.9 cm. Only two significant postoperative complications were encountered, one hardware infection and one cerebrospinal fluid leak. PCVD is an effective procedure in the management of complex craniosynostosis and can be safely initiated very early in life.

scholarly journals Microsurgical clipping of the anterior circulation aneurysms

2018 ◽  
Vol 20 (4) ◽  
pp. 409-414
Author(s):  
Carlos Eduardo Da Silva ◽  
Paulo Eduardo Peixoto De Freitas ◽  
Alicia Del Carmen Becerra Romero ◽  
Fáberson João Mocelin Oliveira ◽  
Márcio Aloisio Bezerra Cavalcanti Rockenbach ◽  
...  
Keyword(s):  
Relevant Literature ◽  
Cerebral Aneurysms ◽  
Series Data ◽  
Anterior Communicating Artery ◽  
Anterior Circulation ◽  
Ruptured Aneurysms ◽  
Microsurgical Clipping ◽  
The Mean ◽  
Anterior Circulation Aneurysms

Introduction: The authors present the analysis of the microsurgical clipping of 100 cerebral aneurysms of the anterior circulation and compare the series data with the literature. Methods: Eighty-eight patients presenting with 100 anterior circulation aneurysms operated on microsurgical techniques between 2002 and 2008 by the first author (CES) were retrospectively reviewed. Results: A total of 88 patients with 100 aneurysms of the anterior circulation were treated in a six years period. Fifty eight female (66%) and thirty male (34%) with nine patients (10.2%) presenting with multiple aneurysms. The mean age was 52 years (range from 26 to 76 years). Eighty five percent of the cases were ruptured aneurysms. The mean follow-up was 52.4 months (range from 5 to 76 months). The topography of the aneurysms was distributed as it follows: Anterior communicating artery (ACoA) 25%; posterior communicating artery (p-comm) 29%; middle cerebral artery (MCA) 27%; paraclinoidal aneurysms 8%; pericallosal artery 6% and internal carotid artery (ICA) tip 5%. The mortality was 7.9%, and such cases presenting with Hunt Hess graduation 3 and 4. The permanent morbidity was 4.5%, cases with Hunt Hess graduation 3 and 4. Perioperative rupture occurred in 17% of the cases, only in previous ruptured aneurysms. There was no clinical evidence of rebleeding during the follow-up period of the series. Conclusions: The microsurgical clipping of cerebral aneurysms of the anterior circulation is a safe and curative treatment for most of such lesions. At present, studies suggest evidences of superior results of surgery compared to the endovascular techniques in the rates of total occlusion of the aneurysms, lesser rates of rebleeding of the treated cases. The results of the present series are similar to the rates of the most relevant literature.

scholarly journals Use of Salt Lake City URBAN 2000 Field Data to Evaluate the Urban Hazard Prediction Assessment Capability (HPAC) Dispersion Model

2005 ◽  
Vol 44 (4) ◽  
pp. 485-501 ◽  
Author(s):  
Joseph C. Chang ◽  
Steven R. Hanna ◽  
Zafer Boybeyi ◽  
Pasquale Franzese
Keyword(s):  
Urban Areas ◽  
Salt Lake ◽  
Dispersion Model ◽  
Salt Lake City ◽  
Model Configuration ◽  
Meteorological Input ◽  
The Mean ◽  
Lake City ◽  
Urban Hazard ◽  
Random Scatter

Abstract After the terrorist incidents on 11 September 2001, there is a greatly heightened concern about the potential impacts of acts of terrorism involving the atmospheric release of chemical, biological, radiological, and nuclear (CBRN) materials in urban areas. In response to the need for an urban CBRN model, the Urban Hazard Prediction Assessment Capability (Urban HPAC) transport and dispersion model has been developed. Because HPAC is widely used by the Department of Defense community for planning, training, and operational and tactical purposes, it is of great importance that the new model be adequately evaluated with urban datasets to demonstrate its accuracy. This paper describes evaluations of Urban HPAC using the “URBAN 2000” urban tracer and meteorological field experiment data from Salt Lake City, Utah. Four Urban HPAC model configuration options and five plausible meteorological input data options—ranging from data-sparse to data-rich scenarios—were considered in the study, thus leading to a total of 20 possible model combinations. For the maximum concentrations along each sampling arc for each intensive operating period (IOP), the 20 Urban HPAC model combinations gave consistent mean overpredictions of about 50%, with a range over the 20 model combinations from no overprediction to a factor-of-4 overprediction in the mean. The median of the random scatter for the 20 model combinations was about a factor of 3 of the mean, with a range over the 20 model combinations between a factor of about 2 and 9. These performance measures satisfy previously established acceptance criteria for dispersion models.

scholarly journals Sampling, Recruitment, and Retention in a Bereavement Intervention Study: Experiences from the Living after Loss Project

2010 ◽  
Vol 61 (3) ◽  
pp. 181-203 ◽  
Author(s):  
Michael Caserta ◽  
Rebecca Utz ◽  
Dale Lund ◽  
Brian de Vries
Keyword(s):  
San Francisco ◽  
Intervention Study ◽  
Salt Lake ◽  
Salt Lake City ◽  
Project Staff ◽  
Effective Strategies ◽  
Recruitment Challenges ◽  
Data Points ◽  
Lake City

This article reports on the sampling and recruitment challenges, as well as the strategies used to address them in the Living After Loss (LAL) project, a bereavement intervention study conducted in Salt Lake City and San Francisco comparing two 14-week group conditions with follow-up. We encountered three major challenges: 1) difficulty determining eligibility for some potential participants who were contacted, 2) locating and recruiting nonwhites, and 3) unavailable phone numbers for approximately one-third of those we attempted to contact. Despite these challenges, we achieved a 42% response rate with a sample size of 328 participants comprising 15% non-white. Eighty-five percent of the participants completed all of the follow-up data points. Leading factors in participants' decisions to join and remain in the study were 1) opportunities to obtain help and support, 2) to potentially help other bereaved individuals, 3) to contribute to research, and 4) their on-going interactions with a professional, empathetic, and culturally sensitive project staff. Effectively focusing recruitment efforts and carefully and systematically training research staff were among the most effective strategies we employed and therefore suggest for those planning similar investigations.

Postneonatal Circumcision: Population Profile

PEDIATRICS ◽  
1990 ◽  
Vol 85 (5) ◽  
pp. 808-812
Author(s):  
Gordon L. Larsen ◽  
Scott D. Williams
Keyword(s):  
Neonatal Period ◽  
Salt Lake ◽  
Salt Lake City ◽  
Care Physician ◽  
Neonatal Complications ◽  
Healthy Infants ◽  
Neonatal Circumcision ◽  
Lake City ◽  
Student’S T

Because postneonatal circumcision includes the risk of general anesthesia and costs more than elective neonatal circumcision, a retrospective study was performed to describe the population currently undergoing postneonatal circumcision and to identify the factors influencing decisions that lead to this procedure. A chart review and follow-up telephone survey were done to gather information concerning patients admitted for postneonatal circumcision to two Salt Lake City hospitals during a 2-year period. From the 135 patients eligible for analysis, two distinct groups emerged: the "sick" group (n = 52)—those who had neonatal complications, and the "well" group (n = 83)—those with no neonatal complications. The median age at circumcision was 5.5 months for the boys in the sick group and 35 months for the boys in the well group (P < .001, Student's t test). During the neonatal period, 32% of families in the well group received anticircumcision advice from their primary care physician. The decision in favor of circumcision was made by two thirds of the families of sick infants before their sons were 6 weeks of age. Other surgery was performed concurrent with the circumcision in 44% of patients in the sick group and 24% of patients in the well group (P < .0001, χ2). Balanitis, phimosis, or a physician's recommendation were listed as the primary reason for postneonatal circumcision by 50% of patents in the well group. Phimosis was listed by the surgeon as an indication for postneonatal circumcision in 65% of all patients's charts, although only 13% of parents listed phimosis as an indication for their children's circumcision. According to this profile of two distinct populations of postneonatal circumcision patients, pediatricians may be able to reduce the incidence of this procedure by providing support of individual preferences and objective information regarding circumcision to families of healthy infants during the neonatal period; by anticipating and facilitating the decisions surrounding neonatal circumcision for families of sick infants; and by educating families of uncircumcised boys about foreskin care and development during regular well-child visits.

scholarly journals Aneurysms with persistent filling after failed treatment with the Pipeline embolization device

2019 ◽  
Vol 130 (4) ◽  
pp. 1376-1382 ◽  
Author(s):  
Badih Daou ◽  
Elias Atallah ◽  
Nohra Chalouhi ◽  
Robert M. Starke ◽  
Jeffrey Oliver ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Previous Treatment ◽  
Anterior Circulation ◽  
Pipeline Embolization Device ◽  
Aneurysm Size ◽  
Paraclinoid Aneurysms ◽  
Long Term Follow Up ◽  
The Mean ◽  
Anterior Choroidal

OBJECTIVEThe Pipeline embolization device (PED) has become a valuable tool in the treatment of cerebral aneurysms. Although failures with PED treatment have been reported, the characteristics and course of these aneurysms remain a topic of uncertainty.METHODSElectronic medical records and imaging studies were reviewed for all patients treated with the PED between July 2010 and March 2015 to identify characteristics of patients and aneurysms with residual filling after PED treatment.RESULTSOf 316 cases treated at a single institution, 281 patients had a long-term follow-up. A total of 52 (16.4%) aneurysms with residual filling were identified and constituted the study population. The mean patient age in this population was 58.8 years. The mean aneurysm size was 10.1 mm ± 7.15 mm. Twelve aneurysms were fusiform (23%). Of the aneurysms with residual filling, there were 20 carotid ophthalmic (CO) aneurysms (20% of all CO aneurysms treated), 10 other paraclinoid aneurysms (16.4% of all paraclinoid aneurysms), 7 posterior communicating artery (PCoA) aneurysms (21.9% of all PCoA aneurysms), 7 cavernous internal carotid artery (ICA) aneurysms (14.9% of all cavernous ICA aneurysms), 4 vertebrobasilar (VB) junction aneurysms (14.8% of all VB junction aneurysms), and 3 middle cerebral artery (MCA) aneurysms (25% of all MCA aneurysms). Eleven patients underwent placement of more than one PED (21.2%), with a mean number of devices of 1.28 per case. Eight of 12 aneurysms were previously treated with a stent (15.4%). Nineteen patients underwent re-treatment (36.5%); the 33 patients who did not undergo re-treatment (63.5%) were monitored by angiography or noninvasive imaging. In multivariate analysis, age older than 65 years (OR 2.65, 95% CI 1.33–5.28; p = 0.05), prior stent placement across the target aneurysm (OR 2.94, 95% CI 1.15–7.51; p = 0.02), aneurysm location in the distal anterior circulation (MCA, PCoA, and anterior choroidal artery: OR 2.72, 95% CI 1.19–6.18; p = 0.017), and longer follow-up duration (OR 1.06, 95% CI 1.03–1.09; p < 0.001) were associated with incomplete aneurysm occlusion.CONCLUSIONSWhile the PED can allow for treatment of large, broad-necked aneurysms with high efficacy, treatment failures do occur (16.4%). Aneurysm size, shape, and previous treatment may influence treatment outcome.

scholarly journals Microsurgical clipping and endovascular flow diversion of ruptured anterior circulation blood blister-like aneurysms

2018 ◽  
Vol 24 (6) ◽  
pp. 615-623 ◽  
Author(s):  
V Hellstern ◽  
M Aguilar-Pérez ◽  
M AlMatter ◽  
P Bhogal ◽  
E Henkes ◽  
...  
Keyword(s):  
Acute Phase ◽  
Clinical Symptoms ◽  
Demographic Data ◽  
Flow Diversion ◽  
Parent Vessel ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Microsurgical Clipping ◽  
Safety Margins

Background Detection and treatment of blister-like intracranial aneurysms as a source of subarachnoid hemorrhage (SAH) can be challenging. In the past the results of both microsurgical and endovascular treatment were difficult. We present our experience with the treatment of blister-like aneurysms in the acute phase of SAH using microsurgical clipping, endovascular parent vessel occlusion or flow diversion. Methods A retrospective analysis of the cases of eight consecutive patients presenting in the acute phase after SAH from an intracranial blister aneurysm was performed. The demographic data of the patients, aneurysm characteristics, the clinical results of the treatment and the follow-up examinations were recorded. Procedural safety margins and aneurysm occlusion on follow-up digital subtraction angiography were the main interest of this evaluation. Results Between January 2012 and November 2017 a total of eight ruptured blister aneurysms were treated in our center, six patients endovascularly. Five patients were treated in the acute phase of SAH, four by flow diversion. All endovascular procedures were feasible and no procedure-related complications were observed, especially no recurrent hemorrhage. In the first angiographic follow-up all blood blister-like aneurysms were completely occluded; two of the six patients treated by flow diverter implantation showed mild, transient intimal hyperplasia without clinical symptoms or the need for treatment. Conclusions Endovascular flow diversion is a viable option in the acute phase after SAH due to the rupture of a blister aneurysm. Implants with reduced thrombogenicity, obviating dual-platelet function inhibition, and flow diverters for vessel bifurcations would extend the indications for this treatment modality.

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