Dale Ding

University of Louisville | UL · Department of Neurological Surgery

Anterior communicating artery (ACom) aneurysm, one of the most frequent types of intracranial aneurysm rupture, usually results in a subarachnoid hemorrhage (SAH) with intraventricular hemorrhage. We describe a case of an ACom aneurysm rupture with subarachnoid, intraparenchymal, and subdural hemorrhages (SDH) with midline shift in a 55-year-old wo...

Here we present a fusiform, partially thrombosed, previously ruptured aneurysm in the posterior cerebral artery that was treated with parent vessel sacrifice after a micro-WADA and micro-balloon test occlusion (video 1). These aneurysms pose treatment challenges due to their deep location, morphology, and potentially eloquent distal supply.1 2 Prim...

BACKGROUND AND OBJECTIVES Stereotactic radiosurgery (SRS) with neoadjuvant embolization is a treatment strategy for brain arteriovenous malformations (AVMs), especially for those with large nidal volume or concomitant aneurysms. The aim of this study was to assess the effects of pre-SRS embolization in AVMs with an associated intracranial aneurysm...

Introduction In the evolving landscape of chronic subdural hematoma (cSDH) treatment, Middle Meningeal Artery Embolization (MMAE) emerges as an adjunct and alternative to conventional surgical drainage (CSD). Three randomized clinical trials demonstrated benefit in terms of reduced recurrence of cSDH and re-operation rates after MMAE. In parallel,...

Introduction Firearm related injuries and fatalities have been steadily increasing over the last two decades. 30,000 firearm-related traumatic brain injuries (TBI) occur in the United States yearly. Mortality remains greater than 50% and morbidity remains high. For those that do survive the initial injury, it is essential to prevent secondary neuro...

Objective Intraoperative rupture (IOR) is the most common adverse event encountered during surgical clip obliteration of ruptured intracranial aneurysms. Besides increasing surgeon experience and early proximal control, no methods exist to decrease IOR risk. Thus, our objective was to assess if partial endovascular coil embolization to protect the...

BACKGROUND AND OBJECTIVES Infratentorial arteriovenous malformations (AVMs) harbor different characteristics compared with supratentorial AVMs. This study aims to explore the unique characteristics of pediatric infratentorial AVMs and their response to single session stereotactic radiosurgery (SRS). METHODS The International Radiosurgery Research...

BACKGROUND AND OBJECTIVES Studies comparing neurological and radiographic outcomes of repeat to initial stereotactic radiosurgery (SRS) intracranial arteriovenous malformations are scarce. Our aim was to perform a retrospective matched comparison of patients initially treated with SRS with those undergoing a second radiosurgical procedure. METHODS...

Semantic segmentation plays an important role in enhancing the diagnostic accuracy from clinical angiographic images. We analyzed 800 cerebral diagnostic subtraction angiography images from 40 patients with Idiopathic Intracranial Hypertension (IIH) and Venous Sinus Stenosis (VSS) using the Segment Anything Model (SAM) with point and box prompting...

Hypothermia in a trauma patient has been associated with increased morbidity and mortality and is more frequently seen in those sustaining traumatic brain injuries (TBIs). Acidosis is an important consequence of hypothermia that leads to derangements across the spectrum of the coagulation cascade. Here, we present a case of a 31-year-old male prese...

Background and objectives: Evidence of the so-called "obesity paradox," which refers to the protective effect and survival benefit of obesity in patients with spontaneous intracerebral hemorrhage (ICH), remains controversial. This study aims to determine the association between body mass index (BMI) and functional outcomes in patients with ICH and...

Background: Whether the use of fludrocortisone affects outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) and its usage rate in the United States remain unknown. Methods: We conducted a retrospective analysis of 78 consecutive patients with a ruptured aSAH at a single academic center in the United States. The primary outcome was th...

Introduction: Endovascular mechanical thrombectomy (MT) is an established treatment for large vessel occlusion strokes with a National Institutes of Health Stroke Scale (NIHSS) score of 6 or higher. Data pertaining to minor strokes, medium, or distal vessel occlusions, and most effective MT technique is limited and controversial. Methods: A mult...

Background Tools predicting intracranial dural arteriovenous fistulas (dAVFs) treatment outcomes remain scarce. This study aimed to use a multicenter database comprising more than 1000 dAVFs to develop a practical scoring system that predicts treatment outcomes. Methods Patients with angiographically confirmed dAVFs who underwent treatment within...

SARS-CoV-2 has been associated with multiple disease processes and chronic sequela. Much less understood are the neurological effects, ranging from headaches, pro-thrombotic state, encephalitis, and myopathic processes. Many case reports have documented post-SARS-CoV-2 virus effects; however, this case highlights the possibility of a less commonly...

INTRODUCTION Investigations of the combined effects of neoadjuvant Onyx embolization and stereotactic radiosurgery (SRS) on brain arteriovenous malformations (AVM) have not accounted for initial angioarchitectural features prior to neuroendovascular intervention. METHODS The International Radiosurgery Research Foundation AVM databases from 1987–20...

A 41-year-old female presented with a headache and left inferior quadrantanopia. Imaging demonstrated a clot spanning the atrium of the ventricle to the superior parietal lobule (SPL), with a small arteriovenous malformation (AVM) nidus outside the atrium of the ventricle. The nidus was supplied by parieto-occipital arterial (P4) feeders with a sin...

BACKGROUND Spontaneous thrombosis of a developmental venous abnormality (DVA) is a rare complication associated with hypercoagulability. The objective of this case report is to describe an association between DVA thrombosis and mild coronavirus disease 2019 (COVID-19) infection in a vaccinated patient. OBSERVATIONS A 28-year-old male with hyperten...

Objective: The role of endovascular mechanical thrombectomy (MT) in patients presenting with "minor" stroke is uncertain. We aimed to compare outcomes after MT for ischemic stroke patients presenting with National Institutes of Health Stroke Scale (NIHSS) 5 and - within the low NIHSS cohort - identify predictors of a favorable outcome, mortality,...

Background Reducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy. Methods This is a retrospective review of the Stroke Thrombectomy and Aneurysm Registry (STAR) database. All patients who underwent AIS thrombectomy with available...

Background: The outcomes of A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) were controversial, and they suggested that intervention is inferior to medical management for unruptured brain arteriovenous malformations (AVMs). However, several studies have shown that stereotactic radiosurgery (SRS) is an acceptable therapy...

Background Hematoma and perihematomal edema volumes are important radiographic markers in spontaneous intracerebral hemorrhage. Accurate, reliable, and efficient quantification of these volumes will be paramount to their utility as measures of treatment effect in future clinical studies. Both manual and semi-automated quantification methods of hema...

Background The role of endovascular mechanical thrombectomy (MT) in patients presenting with ‘minor’ stroke is uncertain. There are also variable definitions reported for ‘minor’ stroke based on the National Institutes of Health Stroke Scale (NIHSS) Objective To compare various cohorts of ‘low’ and ‘high’ NIHSS using cutoff threshold values for NI...

Background Although complete nidal obliteration of brain arteriovenous malformations (AVM) is generally presumed to represent durable cure, postobliteration hemorrhage, and AVM recurrence have become increasingly recognized phenomena. The goal of the study was to define hemorrhage and nidal recurrence risks of obliterated AVMs treated with stereota...

BACKGROUND Cranial dural arteriovenous fistulas with cortical venous drainage are rare lesions that can present with hemorrhage. A high rate of rebleeding in the early period following hemorrhage has been reported, but published long-term rates are much lower. No study has examined how risk of rebleeding changes over time. Our objective was to quan...

INTRODUCTION Prior comparisons of brain arteriovenous malformations (AVMs) treated using stereotactic radiosurgery (SRS) with or without embolization were inherently flawed, due to differences in the pre-treatment nidus volumes. METHODS We retrospectively reviewed International Radiosurgery Research Foundation AVM databases from 1987–2018. Patient...

Intracranial aneurysm is an abnormal dilation of a vessel wall. A multitude of factors have been linked to the development of and risk for rupture of these malformations. The consequences of these vascular abnormalities depend predominantly on whether the aneurysm ruptures. Aneurysmal subarachnoid hemorrhage (aSAH) is a serious condition that is a...

Idiopathic intracranial hypertension (IIH) is a condition of increased intracranial pressure (ICP) with a wide range of symptoms. No single unifying theory for the pathogenesis of IIH exists, but intracranial venous stenosis and congestion have been implicated. Diagnostic procedures to rule out venous sinus stenosis and trans-stenotic pressure grad...

Purpose/Objective(s)To determine, for intact melanoma brain metastases (MBM) treated with single-fraction stereotactic radiosurgery (SRS), whether planning parameter peripheral dose per lesion diameter (PDLDm, Gy/mm) and lesion control (LC) differs with versus without immunotherapy (IO).Materials/Methods We performed a retrospective analysis of pat...

Objective: The long-term safety and efficacy of intrasaccular flow disruption (IFD) for the treatment of brain aneurysms remain unclear. With accumulating experience and increasing use of IFD devices, recent studies have provided additional data regarding their outcomes. This review summarizes the long-term outcomes of IFD-treated brain aneurysms....

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OBJECTIVE A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) suggested that medical management afforded outcomes superior to those following intervention for unruptured arteriovenous malformations (AVMs), but its findings have been controversial. Subsequent studies of AVMs that would have met the eligibility requirements of...

OBJECTIVE Delayed cerebral ischemia (DCI) is a potentially preventable cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). The authors performed a meta-analysis to assess the effect of antiplatelet therapy (APT) on DCI in patients with aSAH. METHODS A systematic review of the PubMed and MEDLINE databases was performed...

Large intracranial lesions are among the most complex and dangerous lesions encountered by neurosurgeons, and a single neurosurgical approach often does not provide a large or safe enough corridor for effective treatment. A combined approach to these surgeries, incorporating open, endoscopic, vascular and keyhole techniques can be more successful....

Aneurysms of the distal anterior inferior cerebellar artery (AICA) are uncommon. They can present with subarachnoid hemorrhage (SAH), cerebellopontine angle syndrome, or a combination of the two. We describe the technique and nuances of microsurgical clipping of a ruptured distal AICA aneurysm using a retrosigmoid approach. After performing the cra...

OBJECTIVE The risk-to-benefit profile of treating an unruptured high-grade dural arteriovenous fistula (dAVF) is not clearly defined. The aim of this multicenter retrospective cohort study was to compare the outcomes of different interventions with observation for unruptured high-grade dAVFs. METHODS The authors retrospectively reviewed dAVF patie...

OBJECTIVE Stereotactic radiosurgery (SRS) provides a safe and effective therapeutic modality for patients with pituitary adenomas. The mechanism of delayed endocrine deficits based on targeted radiation to the hypothalamic-pituitary axis remains unclear. Radiation to normal neuroendocrine structures likely plays a role in delayed hypopituitarism af...

Objective: The optimal treatment paradigm for large arteriovenous malformations (AVMs) is controversial. One approach is volume-staged stereotactic radiosurgery (VS-SRS). The authors previously reported efficacy of VS-SRS for large AVMs in a multiinstitutional cohort; here they focus on risk of symptomatic adverse radiation effects (AREs). Method...

Background and Purpose Dural arteriovenous fistulae can present with hemorrhage, but there remains a paucity of data regarding subsequent outcomes. We sought to use the CONDOR (Consortium for Dural Arteriovenous Fistula Outcomes Research), a multi-institutional registry, to characterize the morbidity and mortality of dural arteriovenous fistula–rel...

Introduction/Purpose Traumatic intracranial aneurysms (TICAs) comprise a rare and particularly dangerous subset of cerebral aneurysms that can be difficult to both diagnose and manage, owing to their locations, morphologies, and presence of concomitant traumatic brain injury (TBI). Materials and Methods We retrospectively reviewed internal databas...

Patients who survive the initial ictus of spontaneous intracerebral hemorrhage (ICH) remain vulnerable to subsequent injury of the perilesional parenchyma by molecular and cellular responses to the hematoma. Secondary brain injury after ICH, which contributes to long-term functional impairment and mortality, has emerged as an attractive therapeutic...

BACKGROUND Pediatric brain arteriovenous malformations (AVMs) are a significant cause of morbidity but the role of multimodal therapy in the treatment of these lesions is not well understood. OBJECTIVE To compare the outcomes of stereotactic radiosurgery (SRS) with and without prior embolization for pediatric AVMs. METHODS We retrospectively eval...

Middle meningeal artery (MMA) embolization has been proposed as a minimally invasive treatment for chronic subdural hematoma (cSDH). The aim of this systematic review and meta-analysis is to compare outcomes after MMA embolization versus conventional management for cSDH. We performed a systematic review of PubMed, Embase, Oxford Journal, Cochrane,...

Background Idiopathic intracranial hypertension (IIH) is a common neurosurgical condition, and the exact pathophysiology remains elusive. Cerebral sinovenous stenosis (CSS) and the resultant decreased venous outflow have been labelled as a potential contributors to the pathophysiology of IIH. We describe the effect of cerebrospinal fluid (CSF) drai...

Background Although the liquid embolic agent, Onyx, is often the preferred embolic treatment for cerebral dural arteriovenous fistulas (DAVFs), there have only been a limited number of single-center studies to evaluate its performance. Objective To carry out a multicenter study to determine the predictors of complications, obliteration, and functi...

Background The benefit of complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 3) over near-complete reperfusion (≥90%, mTICI 2c) remains unclear. The goal of this study is to compare clinical outcomes between mechanical thrombectomy (MT)-treated stroke patients with mTICI 2c versus 3. Methods This is a retrospective study fr...

BACKGROUND Low-grade intracranial dural arteriovenous fistulas (dAVF) have a benign natural history in the majority of cases. The benefit from treatment of these lesions is controversial. OBJECTIVE To compare the outcomes of observation versus intervention for low-grade dAVFs. METHODS We retrospectively reviewed dAVF patients from institutions pa...

Background The relationship between idiopathic intracranial hypertension (IIH) and cerebral sinovenous stenosis (CSS) remains unclear. The effects of cerebrospinal fluid (CSF) diversion on venous sinus physiology have not been rigorously investigated. We describe the effect of ventriculoperitoneal shunt (VPS) placement on sinovenous pressures in th...

BACKGROUND Acute subdural hematomas (aSDHs) occur in approximately 10% to 20% of all closed head injury and represent a significant cause of morbidity and mortality in traumatic brain injury patients. Conventional craniotomy is an invasive intervention with the potential for excess blood loss and prolonged postoperative recovery time. OBJECTIVE To...

OBJECTIVE Investigations of the combined effects of neoadjuvant Onyx embolization and stereotactic radiosurgery (SRS) on brain arteriovenous malformations (AVMs) have not accounted for initial angioarchitectural features prior to neuroendovascular intervention. The aim of this retrospective, multicenter matched cohort study is to compare the outcom...

BACKGROUND Prior comparisons of brain arteriovenous malformations (AVMs) treated using stereotactic radiosurgery (SRS) with or without embolization were inherently flawed, due to differences in the pretreatment nidus volumes. OBJECTIVE To compare the outcomes of embolization and SRS, vs SRS alone for AVMs using pre-embolization malformation featur...

Brain arteriovenous malformations (AVMs) are anomalous direct shunts between cerebral arteries and veins that convalesce into a vascular nidus. The treatment strategies for AVMs are challenging and variable. Intracranial hemorrhage and seizures comprise the most common presentations of AVMs. However, incidental AVMs are being diagnosed with increas...

The Woven EndoBridge (WEB) device is a new endovascular technology that allows safe and effective treatment of wide-neck bifurcation aneurysms without the need for dual antiplatelet therapy.1–4 The case is presented of a patient in their 50 s with a history of systemic lupus erythematosus and receiving warfarin for recurrent deep venous thrombosis...

Background: Embolization of brain arteriovenous malformations (AVMs) using ethylene-vinyl alcohol copolymer (Onyx) embolization may influence the treatment effects of stereotactic radiosurgery (SRS) differently than other embolysates. Objective: To compare the outcomes of pre-SRS AVM embolization with vs without Onyx through a multicenter, retro...

Introduction Blunt cerebrovascular injury (BCVI) can lead to thromboembolic events. The necessity of short-interval noninvasive vascular imaging after the initial diagnosis is controversial. This retrospective cohort assesses the utility of short-interval computed tomography angiography (CTA) after an initial diagnosis of BCVI. Methods We retrospe...

Introduction Pre-hospital identification of patients with large vessel occlusion (LVO) is critical in the timely triage of thrombectomy-eligible LVO patients to comprehensive stroke centers. The Rapid Arterial oCclusion Evaluation (RACE) scale was prospectively validated to identify LVO patients by EMS in Spain and has been widely adopted in the Un...

Introduction Blunt cerebrovascular injury (BCVI) can lead to thromboembolic events. The necessity of short-term repeat vascular imaging after the initial diagnosis is controversial. The aim of this retrospective cohort study is to assess the utility of short-interval computed tomography angiography (CTA) after an initial diagnosis of BCVI. Methods...

Introduction Accurate identification of large vessel occlusion (LVO) strokes in the pre-hospital setting is imperative to reduce time to thrombectomy and improve outcomes. Prior to this study, RACE was the only stroke severity scale designed to detect LVO that had been prospectively validated with Emergency Medical Services (EMS). The goal of our n...

Intro Accurate identification of large vessel occlusion (LVO) strokes in the field may save lives through reduced transport times. Emergency Medical Services (EMS) training is critical to the successful implementation of prehospital screening scales. The prospectively validated 6-item Rapid Arterial oCclusion Evaluation (RACE) scale is a common EMS...

Background and PurposePreclinical and clinical studies have suggested a potential benefit from COX-2 inhibition on secondary injury activation after spontaneous intracerebral hemorrhage (ICH). The aim of this study was to investigate the effect of pre-admission NSAID use on functional recovery in spontaneous ICH patients.Methods Consecutive adult I...

Background Intracranial mycotic aneurysms are uncommon, it can occur due extravascular extension or intravascular seeding of the vessel wall. It often results subarachnoid hemorrhage (SAH) with poor prognosis. We present a rare case of ruptured proximal anterior inferior cerebellar artery- posterior inferior cerebellar artery (AICA-PICA) mycotic an...

OBJECTIVE Stereotactic radiosurgery (SRS) is a treatment option for pediatric brain arteriovenous malformations (AVMs), and early obliteration could encourage SRS utilization for a subset of particularly radiosensitive lesions. The objective of this study was to determine predictors of early obliteration after SRS for pediatric AVMs. METHODS The a...

Oculomotor nerve palsy resulting from non-aneurysmal vascular compression is extremely rare. Microvascular decompression (MVD) has been previously shown to improve oculomotor nerve palsy (ONP) secondary to arterial compression. A 71-year-old female, with a history of Cushing's disease previously treated with two transsphenoidal resections and Gamma...

Carotid artery dissection (CAD) is a diverse clinical condition; patients have variable presentations, broad predisposing factors, and varying severity. Patients with CAD can present with head, face, or neck pain; partial Horner syndrome; focal neurological deficits related to cerebral or retinal ischemia; or no symptoms. Urgent management is essen...

The coexistence of brain tumors and unruptured intracranial aneurysms is uncommon, so there is limited data regarding management strategies for these cases. Tumor, aneurysm, and patient factors must be considered in the decision-making process. We present a case of a dural-based left temporal brain tumor with an incidental ipsilateral unruptured an...

Objective: Central neurocytomas (CNs) are uncommon intraventricular tumors, and their rarity renders the risk-to-benefit profile of stereotactic radiosurgery (SRS) unknown. The aim of this multicenter, retrospective cohort study was to evaluate the outcomes of SRS for CNs and identify predictive factors. Methods: The authors retrospectively anal...

Background: Skull base paragangliomas are highly vascular tumors that are often embolized before surgical resection; however, the safety and efficacy of preoperative embolization using an ethylene vinyl alcohol copolymer (Onyx; Medtronic, Dublin, Republic of Ireland) in these tumors is unknown. This retrospective cohort study evaluated patient out...

Objective Endovascular thrombectomy (ET) for acute large vessel occlusion reduces infarct size, and it should hypothetically decrease the incidence of major ischemic strokes requiring decompressive craniectomy (DC). The aim of this retrospective cohort study is to determine trends in the utilization of ET versus DC for stroke in the United States o...