K Terbrugge

Toronto Western Hospital, Toronto, Ontario, Canada

Are you K Terbrugge?

Claim your profile

Publications (256)749.82 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE/AIM To describe the imaging modalities for evaluating intradural vascular spinal tumors, review their imaging characteristics and the role of preoperative endovascular embolization. CONTENT ORGANIZATION Vascular spinal tumors, in particular hemangioblastoma, paraganglioma, ependymoma and meningioma, have common characteristic imaging features such as hypointense rim in T2WI, serpentine flow voids, intense enhancement after administration of contrast material, and highly vascular appearance in angiography. The role of endovascular embolization is reinforced in this article as an approach that would facilitate the resection of these lesions. SUMMARY Diagnosis of intradural vascular spinal tumors plays an important role in the management and interferes with prognosis and final outcome. Vascular spinal tumors represent a special challenge because of the bleeding that may occur during surgery. Their treatment has benefited from the combination of imaging and technical improvements. Carefully planned endovascular embolization is safe and facilitates the resection of these lesions, becoming the standard of care in the treatment of these tumors.
    Radiological Society of North America 2009 Scientific Assembly and Annual Meeting; 08/2015
  • 05/2015; DOI:10.1038/nrdp.2015.8
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hereditary hemorrhagic telangiectasia (HHT) is a systemic disease characterized by mucocutaneous telangiectasias, epistaxis, and arteriovenous malformations (AVMs). Intracranial hemorrhage (ICH) rates in this population are not well described. We report ICH rates and characteristics in HHT patients with brain AVMs (HHT-BAVMs). We studied the first 153 HHT-BAVM patients with follow-up data enrolled in the Brain Vascular Malformation Consortium HHT Project. We estimated ICH rates after BAVM diagnosis. The majority of patients were women (58%) and white (98%). The mean age at BAVM diagnosis was 31±19 years (range, 0-70), with 61% of cases diagnosed on asymptomatic screening. Overall, 14% presented with ICH; among symptomatic cases, 37% presented ruptured. During 493 patient-years of follow-up, 5 ICH events occurred yielding a rate of 1.02% per year (95% confidence interval, 0.42-2.44%). ICH-free survival differed significantly by ICH presentation (P=0.003); ruptured cases had a higher ICH rate (10.07%; 95% confidence interval, 3.25-31.21%) than unruptured cases (0.43%; 95% confidence interval, 0.11-1.73%). Patients with HHT-BAVM who present with hemorrhage are at a higher risk for rehemorrhage compared with patients with BAVM detected presymptomatically. © 2015 American Heart Association, Inc.
    Stroke 04/2015; DOI:10.1161/STROKEAHA.114.007367 · 6.02 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Growth of an intracranial aneurysm occurs in around 10% of patients at 2-year follow-up imaging and may be associated with aneurysm rupture. We investigated whether PHASES, a score providing absolute risks of aneurysm rupture based on 6 easily retrievable risk factors, also predicts aneurysm growth. In a multicenter cohort of patients with unruptured intracranial aneurysms and follow-up imaging with computed tomography angiography or magnetic resonance angiography, we performed univariable and multivariable Cox regression analyses for the predictors of the PHASES score at baseline, with aneurysm growth as outcome. We calculated hazard ratios and corresponding 95% confidence intervals (CI), with the PHASES score as continuous variable and after division into quartiles. We included 557 patients with 734 unruptured aneurysms. Eighty-nine (12%) aneurysms in 87 patients showed growth during a median follow-up of 2.7 patient-years (range 0.5-10.8). Per point increase in PHASES score, hazard ratio for aneurysm growth was 1.32 (95% CI, 1.22-1.43). With the lowest quartile of the PHASES score (0-1) as reference, hazard ratios were for the second (PHASES 2-3) 1.07 (95% CI, 0.49-2.32), the third (PHASES 4) 2.29 (95% CI, 1.05-4.95), and the fourth quartile (PHASES 5-14) 2.85 (95% CI, 1.43-5.67). Higher PHASES scores were associated with an increased risk of aneurysm growth. Because higher PHASES scores also predict aneurysm rupture, our findings suggest that aneurysm growth can be used as surrogate outcome measure of aneurysm rupture in follow-up studies on risk prediction or interventions aimed to reduce the risk of rupture. © 2015 American Heart Association, Inc.
    Stroke 03/2015; 46(5). DOI:10.1161/STROKEAHA.114.008198 · 6.02 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Basilar trunk aneurysms (BTAs), defined as aneurysms distal to the basilar origin and proximal to the origin of the superior cerebellar artery, are rare and challenging to manage. We describe the natural history and management in a consecutive series of BTAs. Between 2000 and 2013, 2522 patients with 3238 aneurysms were referred to our institution for aneurysm management. A retrospective review of this database was conducted to identify all patients with BTAs. In total, 52 patients had a BTA. Mean age was 56 (SD±18) years. Median clinical follow-up was 33 (interquartile range, 8-86) months, and imaging follow-up was 26 (interquartile range, 2-80.5) months. BTAs were classified into 4 causal subtypes: acute dissecting aneurysms, segmental fusiform ectasia, mural bleeding ectasia, and saccular aneurysms. Multiple aneurysms were more frequently noticed among the 13 saccular aneurysms when compared with overall population (P=0.021). There was preponderance of segmental ectasia or mural bleeding ectasia (P=0.045) in patients presenting with transit ischemic attack/stroke or mass effect. Six patients with segmental and 4 with mural bleeding ectasia demonstrated increasing size of their aneurysm, with 2 having subarachnoid hemorrhage caused by aneurysm rupture. None of the fusiform aneurysms that remained stable bled. BTAs natural histories may differ depending on subtype of aneurysm. Saccular aneurysms likely represent an underlying predisposition to aneurysm development because more than half of these cases were associated with multiple intracranial aneurysms. Intervention should be considered in segmental ectasia and chronic dissecting aneurysms, which demonstrate increase in size over time as there is an increased risk of subarachnoid hemorrhage. © 2015 American Heart Association, Inc.
    Stroke 02/2015; 46(4). DOI:10.1161/STROKEAHA.114.006909 · 6.02 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Unruptured intracranial aneurysms are frequently followed to monitor aneurysm growth. We studied the yield of follow-up imaging and analyzed risk factors for aneurysm growth.
    Stroke 11/2014; 46(1). DOI:10.1161/STROKEAHA.114.005963 · 6.02 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction The purpose of our study was to compare the clinical characteristics and preferential localization of aneurysms in three patient groups: single aneurysm, non-mirror multiple aneurysms, and mirror aneurysms. Methods We retrospectively reviewed the clinical and radiological data of 2223 consecutive patients harboring 3068 aneurysms registered at the Toronto Western Hospital between May 1994 and November 2010. The patients were divided into single, non-mirror multiple, or mirror aneurysm groups. Expected incidences of mirror aneurysms at each location were calculated on the basis of the single aneurysm incidences at each location. Results Patients with mirror aneurysms (n = 197) did not differ from patients with non-mirror multiple aneurysms (n = 392) in having female predominance (81.7 vs. 76.3 %) or a family history of intracranial aneurysm (20.5 vs. 17.6 %). When compared with expected incidences at each location, mirror aneurysms were more frequently found at the cavernous internal carotid artery (30 vs. 11.5 %) (p
    Neuroradiology 10/2014; 57(1). DOI:10.1007/s00234-014-1437-9 · 2.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background and Purpose Management of unruptured fusiform intracranial aneurysms is controversial because of the paucity of natural history data. We studied their natural history and outcome after treatment. Methods We reviewed our neurovascular database from January 2000 to October 2013. Inclusion criteria were unruptured, intradural fusiform aneurysms with a diameter of <2.5 cm. Criteria were developed to define atherosclerotic aneurysms. For outcome assessment, we used the modified Ranking Scale and aneurysm measurements on serial imaging. Mann-Whittney (continuous) and Fisher exact (categorical) tests were used for risk factor analysis. Results For nonatherosclerotic aneurysms (96 patients; 193 person-years follow-up), 1 patient died (rupture) during follow-up (mortality, 0.51% per year) and 8 patients (10%) showed aneurysm progression (risk, 1.6% per year). Risk factors for progression were maximum diameter (>7 mm; odds ratio, 12; 95% confidence interval, 1.4-104) and symptomatic clinical presentation (odds ratio, 16; 95% confidence interval, 3.1-81.4). Of the 23 treated patients, 3 had died (mortality, 12.5%) and 3 had serious disability (modified Ranking Scale, 3; 12.5%). For the atherosclerotic aneurysms (25 patients; 97 person-years follow-up), 5 had died (mortality, 5.2% per year) and 13 of 20 (65%) had aneurysm progression (risk, 12% per year). When compared with patients with nonatherosclerotic aneurysms, case fatality (odds ratio, 19.2; 95% confidence interval, 2.1-172) and aneurysm progression (odds ratio, 17.8; 95% confidence interval, 5.3-56) were higher. Conclusions Nonatherosclerotic fusiform intradural aneurysms have a low risk of adverse outcome within the first few years after diagnosis and remain stable unless symptomatic on presentation or >7 mm in maximum diameter. High risks of treatment should be balanced against this benign natural history. Atherosclerotic aneurysms have a worse natural history and may represent a different disease entity.
    Stroke 09/2014; 45(11). DOI:10.1161/STROKEAHA.114.006292 · 6.02 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To report the epidemiological features, clinical presentation, angiographic characteristics and therapeutic options, success and complication rates in patients with dural carotid cavernous fistulas (dural CCFs).
    European Radiology 07/2014; 24(12). DOI:10.1007/s00330-014-3339-y · 4.34 Impact Factor
  • Young-Jun Lee · Karel G Terbrugge · Guillaume Saliou · Timo Krings
    [Show abstract] [Hide abstract]
    ABSTRACT: Background and Purpose-As a result of the rarity of spinal cord arteriovenous malformations (AVM), there are only a few series available that describe clinical features, outcome after treatment, and natural history of these lesions. In this article, we aim to describe our experience with both nidus-and fistulous-type spinal cord AVMs. Methods-Forty-four consecutive patients with spinal cord AVMs were retrospectively reviewed. There were 26 patients with a nidus-type and 18 patients with a fistulous-type AVM. Treatments were performed with embolization (n=23), surgery (n=13), combined embolization-surgery (n=3), or conservative management (n=5). Clinical features, radiological findings, treatment results, and clinical outcomes were assessed. Results-Patients with nidus-type AVMs were younger at presentation and more often presented with hemorrhage, with a higher proportion of hematomyelia than fistulous-type AVMs (P<0.05). Progression of clinical presentation from hemorrhage to congestive myelopathy during follow-up was noted in 5 patients, all of which had AVMs of the nidus type. Complete obliteration could be achieved more often in the fistulous type (72%) than in the nidus type (27%). Improved or stable clinical status at last follow-up was noted in 100% of fistulous-type and 77% of nidus-type patients. Long-term clinical deterioration was noted in 6 of 26 patients with nidus-type (23%) AVMs and was related to recurrent bleeding (n=3) or progressive venous congestion (n=3). Overall rebleed rate after presentation with hemorrhage was 7 in 145.5 patient-years (4.8%/y) if the lesion was not treated, 3 in 102 patient-years (2.9%/y) after partial treatment, and 0 in 47.5 patient-years (0%) after complete treatment. Conclusions-Nidus and fistulous spinal cord AVMs have different clinical features and obliteration rates, which may affect their long-term prognosis.
    Stroke 07/2014; 45(9). DOI:10.1161/STROKEAHA.114.006087 · 6.02 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to determine the accuracy and utility of contrast-enhanced MR angiography (CE-MRA) in spinal dural arteriovenous fistulas (SDAVF). A retrospective analysis from 1999-2012 identified 70 patients clinically suspected of harboring a SDAVF. Each patient underwent consecutive conventional MR-imaging, CE-MRA, and digital subtraction angiography (DSA). The presence or absence of serpentine flow voids, T2-weighted hyperintensity, and cord enhancement were evaluated, as well as location of the fistula as predicted by CE-MRA. DSA was used as the reference standard. Of the 70 cases, 53 were determined to be a SDAVF, 10 cases were shown to be other forms of vascular malformation, and 7 were DSA-negative. On MRI, all reported cases of SDAVF showed serpentine flow voids (100 %). T2-weighted hyperintensity was seen in 48 of 50 cases (96 %), extending to the conus in 41 of 48 cases (85 %). Cord enhancement was seen in 38 of 41 cases (93 %). CE-MRA correctly localized the SDAVF in 43 of the 53 cases (81 %). CE-MRA is a useful non-invasive examination for the detection and localization of SDAVF. CE-MRA facilitates but does not replace DSA as confirmation of location, fistula type, and arterial detail, which are required before treatment. aEuro cent CE-MRA correctly localized the site of the SDAVF in over 80 % of cases. aEuro cent CE-MRA facilitates diagnostic DSA and expedites the diagnostic process. aEuro cent CE-MRA does not replace diagnostic DSA in SDAVF cases as confirmative test. aEuro cent CE-MRA provides better understanding of missed or mislocalized SDAVF cases.
    European Radiology 07/2014; 24(11). DOI:10.1007/s00330-014-3307-6 · 4.34 Impact Factor
  • A Dmytriw · K terBrugge · T Krings · R Agid
    [Show abstract] [Hide abstract]
    ABSTRACT: Head and neck arteriovenous malformations (H&N AVM) are challenging to treat, and impart clinical and psychosocial morbidity. We evaluated the role of endovascular therapy and its success with varying presentations and characteristics.
    Journal of Neurointerventional Surgery 07/2014; 6 Suppl 1:A34-5. DOI:10.1136/neurintsurg-2014-011343.63 · 2.77 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To describe pregnancy outcomes in women with hereditary hemorrhagic telangiectasia (HHT). This was a retrospective descriptive study of women with HHT (18-55 years of age) from the Toronto HHT Database using a telephone questionnaire regarding pregnancy, delivery, and neonatal outcomes. A total of 244 pregnancies were reported in 87 women with HHT. Miscarriages occurred in 20%. Hereditary hemorrhagic telangiectasia-related complications included minor hemoptysis during two pregnancies (1.1%) and hemothorax during four pregnancies (2.1%). One patient presenting with a hemothorax had presented during a previous pregnancy with a transient ischemic attack, most likely resulting from paradoxical emboli. One patient presented with an intracranial hemorrhage, and one patient presented with heart failure. These complications occurred in women previously unscreened and untreated for arteriovenous malformations. Other complications not clearly related to HHT were deep vein thrombosis (n=1), pulmonary embolism (n=1), myocardial infarction (n=1), and myocardial ischemia (n=1). Women noticed an increased frequency of epistaxis and development of new telangiectases during pregnancy. Epidural or spinal anesthesia was performed in 92 of 185 deliveries (50%) without complications. None of these women had undergone screening for spinal arteriovenous malformation before anesthesia. Women with HHT who have not been screened for arteriovenous malformations are at risk for serious pregnancy complications. LEVEL OF EVIDENCE:: III.
    Obstetrics and Gynecology 02/2014; 197(6). DOI:10.1097/AOG.0000000000000120 · 4.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Unfortunately, two of the authors names, Dae Chul Suh and Michael Soderman, were incorrectly listed as Dae Sul Chuh instead of Dae Chul Suh and Michael Soderman instead of Michael Söderman in the original publication of this paper.
    Interventional Neuroradiology 12/2013; 19(4):519. · 0.73 Impact Factor
  • Source
    Trials 11/2013; 14(Suppl 1):P118. DOI:10.1186/1745-6215-14-S1-P118 · 2.12 Impact Factor
  • The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques 11/2013; 40(6):807-813. · 1.60 Impact Factor
  • I-Chang Su · Karel G Terbrugge · Robert A Willinsky · Timo Krings
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite improvements of embolization agents and techniques, endovascular treatment of spinal dural arterovenous fistula (SDAVF) is still limited by inconsistent success. The aim of embolization is to occlude initial portion of the draining vein by liquid embolic materials. This study investigates factors that contribute to the success of embolization treatments among SDAVF patients. We performed a retrospective analysis on consecutive SDAVF patients who received N-butyl cyanoacrylate (NBCA) glue embolization between January 1992 and June 2012. Univariable and multivariable logistic regression analyses were performed to calculate the probability of successful draining vein occlusion for variable procedure-related factors. We attempted endovascular approach as the first intention treatment in 66 out of 90 consecutive patients. Among them, a total of 43 NBCA glue injections were performed in 40 patients. Successful embolization was achieved in 24 patients (60 %). In multivariable analyses, antegrade flow during microcatheter test injection (OR 13.2, 95 % CI 1.7 to 105.4) and use of glue concentration ≥30 % (OR 0.1, 95 % CI 0.01 to 0.8) were detected as significant positive and negative predictors of successful venous penetration, respectively. With persistent antegrade flow, the success rates using a glue mixture of more than 30 % dropped significantly from 85.0 to 42.9 % (p = 0.049). If contrast stagnated during microcatheter injections, success rates were low regardless of glue concentrations. Presence of antegrade flow toward the draining vein and injection of NBCA glue less than 30 % are associated with higher chance of draining vein penetration and, therefore, successful endovascular SDAVF obliteration.
    Neuroradiology 10/2013; 55(11). DOI:10.1007/s00234-013-1285-z · 2.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Interventional Neuroradiology (INR) is not bound by the classical limits of a speciality, and is not restricted by standard formats of teaching and education. Open and naturally linked towards neurosciences, INR has become a unique source of novel ideas for research, development and progress allowing new and improved approaches to challenging pathologies resulting in better anatomo-clinical results. Opening INR to Neurosciences is the best way to keep it alive and growing. Anchored in Neuroradiology, at the crossroad of neurosciences, INR will further participate to progress and innovation as it has often been in the past.
    Interventional Neuroradiology 09/2013; 19(3):263-70. · 0.73 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Object The authors describe the clinical presentation, imaging features, and management of patients presenting with filum terminale arteriovenous fistulas (FTAVFs) and the role of transarterial treatment in their management. Methods The authors retrospectively reviewed data obtained in 10 patients with FTAVFs diagnosed between January 1990 and December 2011. Results Most patients (70%) were male, and the age of the population ranged from 31 to 72 years (mean 58.2 years). Clinical presentation was progressive paraparesis and sensory loss in the lower extremities in 9 cases, back pain in 7, radicular pain in 3, bowel/bladder disturbance in 5, and impotence in 1. The duration of symptoms varied between 2 and 24 months. Initial MRI studies showed intramedullary increased T2 signal, swollen cord, and dilated perimedullary veins in all patients. One patient had syringomyelia, presumably caused by venous hypertension transmitted by the perimedullary venous system. Embolization was attempted in 7 patients and was curative in 6 patients. Surgery was performed in the other 4 patients in whom embolization was unsuccessful or deemed not feasible. There was no treatment-related complication in either group. Symptoms, venous congestion in the cord, and syringomyelia improved on follow-up in all patients. Conclusions Embolization should be considered the treatment of choice for FTAVFs and can effectively treat the majority of patients presenting with an FTAVF. In a smaller group of patients in whom the angioarchitecture is unfavorable, open surgery is recommended.
    Journal of neurosurgery. Spine 05/2013; 19(1). DOI:10.3171/2013.4.SPINE12685 · 2.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND AND PURPOSE:Seizures are a common presentation in patients with brain arteriovenous malformations, but the pathogenesis of seizures remains poorly understood. The purpose of our study was to analyze various morphologic and hemodynamic characteristics of unruptured BAVMs presenting primarily with seizures and, on the basis of these, to propose a scoring system to predict seizures in patients with BAVMs.MATERIALS AND METHODS:In a retrospective review of our BAVM data base from 2000 to 2009, after excluding patients with ruptured BAVMs, we classified patients into 2 groups, those with and without seizures at presentation. Clinical, angiographic, and hemodynamic characteristics on cerebral angiograms of all these patients were studied. The association between various angioarchitectural variables and seizure presentation was examined, and these results were used to guide the development of criteria to predict presentation with seizures.RESULTS:Of 1299 patients in our data base, we finally analyzed 33 patients with unruptured BAVMs with seizures and 45 patients with unruptured AVMs without seizures. Location, fistulous component in the nidus, venous outflow stenosis, and the presence of a long pial course of the draining vein were identified as the strongest predictors of seizures. The proposed scoring system had good predictability of presentation with seizures.CONCLUSIONS:Specific angioarchitectural characteristics of unruptured BAVMs may predict occurrence of seizures and may help in targeted treatment.
    American Journal of Neuroradiology 11/2012; 34(5). DOI:10.3174/ajnr.A3361 · 3.68 Impact Factor

Publication Stats

5k Citations
749.82 Total Impact Points

Institutions

  • 1986–2015
    • Toronto Western Hospital
      Toronto, Ontario, Canada
  • 2014
    • University Medical Center Utrecht
      • Department of Neurosurgery
      Utrecht, Utrecht, Netherlands
  • 2004–2014
    • University Health Network
      • • Joint Department of Medical Imaging
      • • Department of Medical Imaging
      Toronto, Ontario, Canada
    • Leiden University Medical Centre
      • Department of Radiology
      Leiden, South Holland, Netherlands
  • 1991–2014
    • University of Toronto
      • • Department of Medical Imaging
      • • Division of Neurosurgery
      • • Department of Surgery
      • • Department of Anesthesia
      • • Hospital for Sick Children
      Toronto, Ontario, Canada
    • Université Paris-Sud 11
      Orsay, Île-de-France, France
  • 2010
    • Leiden University
      Leyden, South Holland, Netherlands
  • 2009
    • Gyeongsang National University
      • Department of Radiology
      Chinju, South Gyeongsang, South Korea
  • 2006
    • McMaster University
      • Division of Neurosurgery
      Hamilton, Ontario, Canada
    • Tuen Mun Hospital
      • Department of Neurosurgery
      Hong Kong, Hong Kong
  • 2005
    • Buddhist Tzu Chi General Hospital
      T’ai-pei, Taipei, Taiwan
  • 2003–2004
    • Shantou University
      Swatow, Guangdong, China
    • Queen Mary Hospital
      Hong Kong, Hong Kong
    • Catholic University of Korea
      • Department of Radiology
      Sŏul, Seoul, South Korea
  • 2001
    • Hospital Garcia de Orta
      Almada, Setúbal, Portugal
  • 1999
    • University of British Columbia - Vancouver
      • Department of Surgery
      Vancouver, British Columbia, Canada
  • 1989
    • SickKids
      Toronto, Ontario, Canada