Van Halbach

Van Halbach
University of California, San Francisco | UCSF · Department of Radiology and Biomedical Imaging

MD

About

387
Publications
13,396
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
17,009
Citations
Introduction
Additional affiliations
July 1986 - January 2016
University of California, San Francisco
Position
  • Program Director Interventional Neuroradiology Section, Clinical Professor of Radiology, Neurological Surgery, and Neurology

Publications

Publications (387)
Article
Full-text available
Background Giant cell arteritis (GCA) is a systemic vasculitis that may cause ischemic stroke. Rarely, GCA can present with aggressive intracranial stenoses, which are refractory to medical therapy. Endovascular treatment (EVT) is a possible rescue strategy to prevent ischemic complications in intracranial GCA but the safety and efficacy of EVT in...
Article
Full-text available
Background and Purpose: The management of unruptured intracranial aneurysms remains controversial. The decisions to treat are heavily informed by estimated risk of bleeding. However, these estimates are imprecise, and better methods for stratifying the risk or tailoring treatment strategy are badly needed. Here, we demonstrate an initial proof-of-p...
Article
Although enthusiasm for transradial access for neurointerventional procedures has grown, a unique set of considerations bear emphasis to preserve safety and minimize complications. In the first part of this review series, we reviewed anatomical considerations for safe and easy neuroendovascular procedures from a transradial approach. In this second...
Article
Although enthusiasm for transradial access for neurointerventional procedures has grown, a unique set of considerations bear emphasis to preserve safety and minimize complications. In the first part of this review series, we will review important anatomical considerations for safe and easy neuroendovascular procedures from a transradial approach. T...
Article
The simultaneous growth of robotic-assisted surgery and telemedicine in recent years has only been accelerated by the recent coronavirus disease 2019 pandemic. Robotic assistance for neurovascular intervention has garnered significant interest due to opportunities for tele-stroke models of care for remote underserved areas. Lessons learned from med...
Conference Paper
Background Giant cell arteritis (GCA) is a systemic vasculitis that causes ischemic stroke in 2-7% of patients, typically due to extracranial vessel inflammation. However, in rare instances, GCA can present with fulminant intracranial stenoses which are refractory to medical therapy. In these cases, endovascular treatment (EVT) is a possible rescue...
Conference Paper
Background and Purpose Intra-arterial chemotherapy (IAC) infusion for the treatment of intraocular retinoblastoma is an effective and relatively safe therapeutic option.1–3 However, one of the well described systemic complications following IAC is neutropenia.⁴ The purpose of this retrospective study is to examine the incidence of neutropenia over...
Conference Paper
Background and Purpose Pediatric neurointerventional radiology is an evolving subspecialty with growing indications and technological advancement such as miniaturization of devices. The ability to perform these procedures is continuously balanced with necessity given the inherently higher risks of radiation1,2 and cerebrovascular injury in infants....
Article
Full-text available
Large, wide-necked basilar apex aneurysms are difficult to treat. Microsurgical clipping can result in neurologic morbidity and mortality. Endovascular treatment often leaves remnants that need retreatment and/or stent placement with dual antiplatelet therapy. The Woven EndoBridge (WEB) is an intrasaccular flow disruption device that can be used wi...
Article
Background Dural arteriovenous fistulas (AVF) of the foramen magnum region (FMR) are technically challenging lesions to treat. Transvenous (TV), transarterial (TA), and surgical approaches have been described, but the optimum treatment strategy is not defined. Objective To report treatment strategies and outcomes for FMR-AVF at a single, high-volu...
Article
Background and purpose: AVFs of the foramen magnum region, including fistulas of the marginal sinus and condylar veins, have complex arterial supply, venous drainage, symptoms, and risk features that are not well-defined. The purpose of this study was to present the angioarchitectural and clinical phenotypes of a foramen magnum region AVF from a l...
Article
The use of intracranial stents in neurointerventional surgery has been practiced for decades. However, the spectrum of treatable pathology, available devices, and clinical adoption of intracranial stents has exploded in recent years. Diagnostic neuroradiologists play a critical role in the evaluation of these devices after deployment, yet may not b...
Article
Background For patients with acute ischemic stroke undergoing endovascular mechanical thrombectomy with x-ray angiography, the use of adjuncts to maintain vessel patency, such as stents or antiplatelet medications, can increase risk of periprocedural complications. Criteria for using these adjuncts are not well defined. Purpose To evaluate use of M...
Article
Full-text available
BACKGROUND The authors recently reported a series of children with vertebral artery (VA) compression during head turning who presented with recurrent posterior circulation stroke. Whether VA compression occurs during head positioning for cranial surgery is unknown. OBSERVATIONS The authors report a case of a child with incidental rotational occlus...
Chapter
Complications are an unfortunate reality in the field of interventional neuroradiology. While complications cannot be eliminated entirely, their occurrence and severity can be mitigated by the competency achieved through training, knowledge of cerebrovascular anatomy and pathology, and well-conceived and executed plans crafted in conjunction with a...
Chapter
Dural arteriovenous fistulae (dAVFs) are diverse, complex lesions that share the common feature of arteriovenous shunting without an intervening nidus. In this chapter, the ensuing discussion is organized by dAVF location, followed by further consideration of less common, distinct types of dAVFs—carotid cavernous fistulae, pial arteriovenous fistul...
Article
Background and purpose: Automated CTP software is increasingly used for extended window emergent large-vessel occlusion to quantify core infarct. We aimed to assess whether RAPID software underestimates core infarct in patients with an extended window recently receiving IV iodinated contrast. Materials and methods: We reviewed a prospective, sin...
Article
Background and purpose: Hemodynamic features of brain AVMs may portend increased hemorrhage risk. Previous studies have suggested that MTT is shorter in ruptured AVMs as assessed on quantitative color-coded parametric DSA. This study assesses the interrater reliability of MTT measurements obtained using quantitative color-coded DSA. Materials and...
Article
Background and purpose: Do children have an increased risk for brain arteriovenous malformation (AVM) recurrence compared with adults and does this risk vary depending on initial presentation with AVM rupture? Methods: We retrospectively studied 115 patients initially presenting with brain AVM under age 25 years who underwent complete surgical r...
Article
Background: Carotid cavernous fistulas (CCF) often present with diplopia secondary to cranial nerve palsy (CNP). Immediate development of postoperative CNP has been described in the literature. This study described delayed-onset of CNP after complete and reconfirmed obliteration of the CCF and resolution of initial CNP. Methods: A retrospective...
Article
Objective To describe a pediatric stroke syndrome with chronic focal vertebral arteriopathy adjacent to cervical abnormalities. Methods At a single pediatric stroke center, we identified consecutive children with stroke and vertebral arteriopathy of the V3 segment with adjacent cervical bony or soft tissue abnormalities. We abstracted clinical pre...
Article
Background and purpose: Arterial access is a technical consideration of mechanical thrombectomy that may affect procedural time, but few studies exist detailing the relationship of anatomy to procedural times and patient outcomes. We sought to investigate the respective impact of aortic arch and carotid artery anatomy on endovascular procedural ti...
Conference Paper
Background and Purpose Automated computed tomography perfusion (CTP) software is increasingly utilized to aid in treatment decisions in emergent large vessel occlusion (ELVO), particularly in extended window stroke patients. Neurointerventionalists must be cognizant of pitfalls of these software packages in predicting ischemic core and penumbra. Th...
Article
OBJECTIVE Preoperative embolization of brain arteriovenous malformations (AVMs) is performed to facilitate resection, although its impact on surgical performance has not been clearly defined. The authors tested for associations between embolization and surgical performance metrics. METHODS The authors analyzed AVM cases resected by one neurosurgeo...
Article
Introduction Indirect cavernous carotid fistulae (ICCFs) can present with insidious, non-specific symptoms and prove difficult to diagnose. This study evaluates associations among ICCF symptoms and angiographic findings. Methods A retrospective analysis was performed of prospectively maintained records at four medical centers to identify patients...
Article
Introduction: Arterial access is a technical consideration of mechanical thrombectomy that may affect procedure time. Few studies exist detailing the impact of aortic arch and carotid anatomy on procedure times and patient outcomes. Methods: We included 56 patients who underwent embolectomy with successful revascularization for acute ischemic strok...
Article
Background: Endovascular surgery is the first-line treatment for indirect cavernous carotid fistulae (CCFs). This study compares multiple treatment techniques. Objective: To compare endovascular techniques for indirect CCF treatment. Methods: Retrospective analysis was performed of prospectively maintained records at 4 centers, identifying pat...
Conference Paper
Introduction Endovascular surgery became the first line modality for treatment of indirect cavernous carotid fistulae (CCFs) as neurointerventional radiology matured in the 1980s. For approximately thirty years transvenous coiling of the cavernous sinus has been considered the safest and most efficacious technique. This retrospective multicenter re...
Article
Purpose The aim was to evaluate the impact of protocol changes in selective ophthalmic arterial infusion (SOAI) for treatment of retinoblastoma (Rb). Methods A retrospective review was completed of 35 patients with Rb who were treated with SOAI between March 2010 and January 2017. Treatment details were tabulated for each SOAI session. SOAI protoc...
Article
Full-text available
There is limited data describing endothelial cell (EC) gene expression between aneurysms and arteries partly because of risks associated with surgical tissue collection. Endovascular biopsy (EB) is a lower risk alternative to conventional surgical methods, though no such efforts have been attempted for aneurysms. We sought (1) to establish the feas...
Article
Background and purpose The purpose of this article is to estimate the distribution of superselective intra-arterial chemotherapy (IAC) delivery to ocular target tissue using quantitative digital subtraction angiography (qDSA). Materials and methods From March 2010 to January 2016, 50 ophthalmic artery contrast DSAs obtained immediately prior to IA...
Data
Predictors of TIA at last contact beyond discharge
Data
Predictors of stroke at last contact beyond discharge
Data
Predictors of mRS ≥3 at last contact beyond discharge
Article
Purpose Earlier reperfusion of large-vessel occlusion (LVO) stroke improves functional outcomes. We hypothesize that use of a stroke cart in the angiography suite, containing all commonly used procedural equipment in a mechanical thrombectomy, combined with parallel staff workflows, and use of conscious sedation when possible, improve mechanical th...
Article
Background and purpose: Although intracranial dural arteriovenous fistulas are principally supplied by dural branches of the external carotid, internal carotid, and vertebral arteries, they can also be fed by pial arteries that supply the brain. We sought to determine the frequency of neurologic deficits following treatment of intracranial dural a...
Article
Dural arteriovenous fistulas (DAVFs) can be complex lesions that require a well trained eye for proper characterization and management decisions. With numerous possible arteries to supply and veins to drain them, DAVFs are often complex lesions. To best treat these complex lesions, the neurointerventionalist should be adept at treating them with mu...
Article
Introduction: Cerebral aneurysms affect 1-6% of the population and their rupture carries significant mortality and morbidity. The paucity of data related to histopathological features of aneurysms stems largely from the risks associated with aneurysm tissue collection. We set out to establish a feasible technique to isolate viable endothelial cells...
Article
Pulsatile Tinnitus (PT) is a pulse-synchronous sound heard in the absence of an external source. PT is often related to abnormal flow in vascular structures near the cochlea. One vascular territory implicated in PT is the internal jugular vein (IJV). Using computational fluid dynamics (CFD) based on patient-specific Magnetic Resonance Imaging (MRI)...
Article
Aberrations in flow in the cerebral venous outflow tract (CVOT) have been implicated as the cause of several pathologic conditions including idiopathic intracranial hypertension (IIH), multiple sclerosis (MS), and pulsatile tinnitus (PT). The advent of 4D Flow magnetic resonance imaging (4D-Flow MRI) has recently allowed researchers to evaluate blo...
Article
Full-text available
Background and Purpose To evaluate the ability of IA MR perfusion to characterize meningioma blood supply. Methods Studies were performed in a suite comprised of an x-ray angiography unit and 1.5T MR scanner that permitted intraprocedural patient movement between the imaging modalities. Patients underwent intra-arterial (IA) and intravenous (IV) T...
Article
Introduction/purpose: To achieve aneurysm occlusion, flow diverters (FDs) must be accurately sized to maximize coverage over the neck and induce thrombosis. Catheterization for diagnostic angiography can cause vasospasm that may affect vessel measurements. This study evaluates impacts of intra-arterial infusion of a calcium channel blocker (CCB) o...
Article
Full-text available
OBJECTIVE Intracranial dural arteriovenous fistulas (DAVFs) are rare in children. This study sought to better characterize DAVF presentation, angioarchitecture, and treatment outcomes. METHODS Children with intracranial DAVFs between 1986 and 2013 were retrospectively identified from the neurointerventional database at the authors' institution. De...
Article
Dural arteriovenous fistulas (DAVFs) can be complex lesions that require a well trained eye for proper characterization and management decisions. With numerous possible arteries to supply and veins to drain them, DAVFs are often complex lesions. To best treat these complex lesions, the neurointerventionalist should be adept at treating them with mu...
Article
Dural arteriovenous fistulas (DAVFs) can be complex lesions that require a well trained eye for proper characterization and management decisions. With numerous possible arteries to supply and veins to drain them, DAVFs are often complex lesions. To best treat these complex lesions, the neurointerventionalist should be adept at treating them with mu...
Article
Full-text available
Introduction/purpose To best achieve complete occlusion of aneurysms treated with flow diverters (FDs), devices must be accurately sized to precisely match the parent vessel diameter. Appropriately sized FDs will have maximal coverage over the aneurysm neck and will be more likely to induce thrombosis. Catheterization for diagnostic angiography can...
Article
Full-text available
Introduction/purpose Aberrations of venous anatomy can cause pulsatile tinnitus (PT). However, venous anatomy variation in patients without pulsatile tinnitus (PT) is extremely variable. Conventional imaging modalities, including cerebral angiography, provide little insight into the complex flow patterns in the cerebral veins. The aim of this study...
Article
Full-text available
Introduction/purpose Numerous processes can cause pulsatile tinnitus (PT), some of which are potentially life threatening. This case series describes a cause of PT – prominent condylar veins – that has undergone little investigation to date. This report characterizes angiographic findings in patients with prominent condylar veins and means to local...
Article
Full-text available
Introduction/purpose Sigmoid sinus diverticulum (SSD) is one of the potentially treatable causes of pulsatile tinnitus (PT). How SSD causes PT is unknown, but it is thought to be secondary to aberrant blood flow in the diverticulum or parent sinus. We performed velocity field mapping using MR 4 D Flow (MRV) and computational fluid dynamics (CFD) in...
Article
Full-text available
Introduction/purpose Pulsatile tinnitus (PT) has been linked to multiple anatomical variants of the venous outflow tract including sigmoid sinus diverticulum (SSD). We hypothesize that turbulence generated by the SSD, which is normally preceded by a transverse sinus stenosis (TSS), can explain the source of sound. Turbulent flow has a known associa...
Article
BACKGROUND The treatment of dolichoectatic basilar trunk aneurysms has been ineffectual or morbid due to nonsaccular morphology, deep location, and involvement of brainstem perforators. Treatment with bypass surgery has been advocated to eliminate malignant hemodynamics and to stabilize aneurysm growth. OBJECTIVE To validate that flow alteration w...
Article
A 13-year-old boy with meningiomatosis, McCune-Albright syndrome, and gray platelet syndrome presented with an enlarging "lump" on his right forehead. A head CT scan revealed a polyostotic fibrous dysplasia involving the entire skull. A 3.4-cm right frontal osseous cavity and an overlying right forehead subcutaneous soft-tissue mass were seen, meas...
Article
In the endovascular treatment of cerebral arteriovenous malformations, ethanol sclerotherapy is seldom used due to safety concerns. However, when limited reflux of an embolic agent is permissible or when there is a long distance to the target, ethanol may be preferable. We reviewed 10 patients with 14 cerebral AVM feeding artery aneurysms or intran...
Article
OBJECT Retroclival hematomas are rare, appearing mostly as posttraumatic phenomena in children. Spontaneous retroclival hematoma (SRH) in the absence of trauma also has few descriptions in the literature. None of the reported clinical cases features the combination of an SRH and intraventricular hemorrhage (IVH). Nevertheless, despite extensive cas...
Article
Full-text available
Purpose: To develop a strategy of achieving targeted collection of endothelial cells (ECs) by endovascular methods and analyzing the gene expression profiles of collected single ECs. Methods and results: 134 ECs and 37 leukocytes were collected from four patients' intra-iliac artery endovascular guide wires by fluorescence activated cell sorting...
Article
Full-text available
A minority of intracranial dural arteriovenous fistulas progress with time. We sought to determine features that predict progression and define outcomes of patients with progressive dural arteriovenous fistulas. We performed a retrospective imaging and clinical record review of patients with intracranial dural arteriovenous fistula evaluated at our...
Article
OBJECT Large arteriovenous malformations (AVMs) remain difficult to treat, and ideal treatment parameters for volume-staged stereotactic radiosurgery (VS-SRS) are still unknown. The object of this study was to compare VS-SRS treatment outcomes for AVMs larger than 10 ml during 2 eras; Era 1 was 1992-March 2004, and Era 2 was May 2004–2008. In Era 2...
Article
Background Embolic agents for embolization of cerebral arteriovenous malformations (AVMs) currently include n-BCA, Onyx, particles, and detachable coils. Ethanol sclerotherapy is seldom used in the treatment of cerebral AVMs due to safety concerns.1,2 In some circumstances, however, such as when limited reflux of an embolic agent is permissible, th...
Article
Introduction Giant intracranial aneurysms present a danger of hemorrhage, mass effect, and thromboembolism. Fusiform or wide-necked aneurysms not amenable to clipping or coiling can be sometimes treated by indirect trapping or by deployment of a flow-diverter device. Such interventions are aimed at reducing the flow through the aneurysm in the hope...
Article
Purpose To evaluate the ability of intravenous (IV) and intraarterial (IA) MR perfusion to characterize meningioma blood supply. Materials and methods Institutional review board approval and informed consent were obtained for this prospective, HIPAA-compliant study. Studies were performed in a suite comprised of an x-ray angiography unit and 1.5T M...