Cessation and Resumption of Elective Neurointerventional Procedures during the Coronavirus Disease 2019 Pandemic and Future Pandemics

At the time of this writing, the coronavirus disease 2019 pandemic continues to be a global threat, disrupting usual processes, and protocols for delivering health care around the globe. There have been significant regional and national differences in the scope and timing of these disruptions. Many hospitals were forced to temporarily halt elective neurointerventional procedures with the first wave of the pandemic in the spring of 2020, in order to prioritize allocation of resources for acutely ill patients and also to minimize coronavirus disease 2019 transmission risks to non-acute patients, their families, and health care workers. This temporary moratorium on elective neurointerventional procedures is generally credited with helping to flatten the curve and direct scarce resources to more acutely ill patients; however, there have been reports of some delaying seeking medical care when it was in fact urgent, and other reports of patients having elective treatment delayed with the result of morbidity and mortality. Many regions have resumed elective neurointerventional procedures, only to now watch coronavirus disease 2019 positivity rates again climbing as winter of 2020 approaches. A new wave is now forecast which may have larger volumes of hospitalized coronavirus disease 2019 patients than the earlier wave(s) and may also coincide with a wave of patients hospitalized with seasonal influenza. This paper discusses relevant and practical elements of cessation and safe resumption of nonemergent neurointerventional services in the setting of a pandemic

Opening Pressure Assessment Following Venous Stenting for Idiopathic Intracranial Hypertension (.pdf)

Increasing evidence supports a role of venous sinus stenosis in the pathogenesis of idiopathic intracranial hypertension (IIH). Numerous retrospective studies have demonstrated improvement in symptoms and papilledema after stenting, but few have diligently compared pre and post opening pressure (OP). We measured the pre and post OP in 19 patients who underwent stenting for IIH, 10 of whom were enrolled in a prospective trial evaluating the effect of stenting on visual fields and optic nerve morpholog

Delayed Onset Craniosynostosis Presenting as Idiopathic Intracranial Hypertension

Craniosynostosis refers to premature fusion of one or more cranial sutures, and typically presents with abnormal head shape within the first year of life. Management includes cranial vault reconstruction (CVR) or observation. Rarely, suture fusion may occur later in childhood or go unnoticed. These delayed cases may not be associated with changes in head shape and come to attention only because of an elevation in intracranial pressure. We present five children referred for presumed pediatric idiopathic intracranial hypertension (IIH) who fulfilled the modified Dandy criteria for the disease but were ultimately found to have sagittal craniosynostosis as the cause of papilledema. We review presenting symptoms and signs, associated radiological findings, management and clinical course

Venous Sinus Stenting Improves Visual Fields and Cerebrospinal Fluid Opening Pressures in Idiopathic Intracranial Hypertension

Idiopathic intracranial hypertension (IIH) causes headache and potentially irreversible visual loss, mostly in obese women of childbearing age. Treatment includes weight loss, acetazolamide, and surgical interventions when medications fail. Venous sinus stenting (VSS) has recently emerged as a promising treatment for IIH patients with dural venous sinus stenosis (DSS) but only a minority of studies have studied post-stent opening pressure (OP) or quantitative visual field scores

Glomus Jugulare Tumor Induced Intracranial Hypertension

Pseudotumor cerebi syndrome (PTCS), the categorical term for primary and secondary causes of raised intracranial pressure (ICP) in the absence of space-occupying lesion, has a characteristic presentation that includes frequent headaches, visual changes, pulsatile tinnitus with papilledema. Neuroimaging is an essential step in PCTS diagnosis. We present a unique case, originally thought to be a presentation of primary PTCS, later revealed as PTCS secondary to a glomus jugulare tumor, causing venous outflow obstruction and consequential intracranial hypertension, which was treated with venous stenting and post-stent balloon angioplasty of the right internal jugular vein

Simulation of superselective catheterization for cerebrovascular lesions using a virtual injection software

Abstract Background This report addresses the feasibility of virtual injection software based on contrast-enhanced cone-beam CTs (CBCTs) in the context of cerebrovascular lesion embolization. Intracranial arteriovenous malformation (AVM), dural arteriovenous fistula (AVF) and mycotic aneurysm embolization cases with CBCTs performed between 2013 and 2020 were retrospectively reviewed. Cerebrovascular lesions were reviewed by 2 neurointerventionalists using a dedicated virtual injection software (EmboASSIST, GE Healthcare; Chicago, IL). Points of Interest (POIs) surrounding the vascular lesions were first identified. The software then automatically displayed POI-associated vascular traces from vessel roots to selected POIs. Vascular segments and reason for POI identification were recorded. Using 2D multiplanar reconstructions from CBCTs, the accuracy of vascular traces was assessed. Clinical utility metrics were recorded on a 3-point Likert scale from 1 (no benefit) to 3 (very beneficial). Results Nine cases (7 AVM, 1 AVF, 1 mycotic aneurysm) were reviewed, with 26 POIs selected. Three POIs were in 2nd order segments, 8 POIs in 3rd order segments and 15 POIs in 4th order segments of their respective arteries. The reviewers rated all 26 POI traces – involving a total of 90 vascular segments – as accurate. The average utility score across the 8 questions were 2.7 and 2.8 respectively from each reviewer, acknowledging the software’s potential benefit in cerebrovascular embolization procedural planning. Conclusion The operators considered CBCT-based virtual injection software clinically useful and accurate in guiding and planning cerebrovascular lesion embolization in this retrospective review. Future prospective studies in larger cohorts are warranted for validation of this modality

Legislative Documents

Also, variously referred to as: House bills; House documents; House legislative documents; legislative documents; General Court documents

Venous Sinus Stenting for Idiopathic Intracranial Hypertension: Impact on Headache-Specific Quality of Life Scores

Venous sinus stenting (VSS) for treatment of idiopathic intracranial hypertension (IIH) has emerged as a viable alternative treatment to traditional surgical interventions. Headache, the most common symptom in IIH, may persist after the resolution of papilledema consistent with successful treatment response. Formal assessment of headache impact on quality of life (QOL) by questionnaireprovides valuable information and better understanding for patients and doctors regarding treatment progress and outcome. We assessed headache-specific QOL (HQOL) scores and CSF opening pressure (OP) before and after VSS. We hypothesized that postoperative improvement in HQOL scores would correlate with improvement in CSF-OP

Summary of mean sinus measurements (D_max, area and perimeter), 95% confidence intervals and range of measurements based on acquisition technique.

<p>Summary of mean sinus measurements (D_max, area and perimeter), 95% confidence intervals and range of measurements based on acquisition technique.</p