Christopher S Ogilvy

Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

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Publications (366)1203.45 Total impact

  • Matthew R Fusco · Christopher S Ogilvy
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    ABSTRACT: -A review of the submitted manuscript is presented with special emphasis on the interesting finding of worse performance of ICGA in ophthalmic aneurysms-Critical review of the existing literature on ICGA in the treatment of aneurysms, focusing on its ease of use and effectiveness as strengths while discussing its limitations in deep seated aneurysms (ophthalmic, anterior communicating, and posterior circulation)-Call for prospective and randomized trial comparing both ICGA and intra-operative angiography to the gold standard of post-operative angiography
    No preview · Article · Aug 2014 · World Neurosurgery
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    ABSTRACT: Objective: To determine whether the CT angiography (CTA) spot sign marks bleeding complications during and after surgery for spontaneous intracerebral hemorrhage (ICH). Methods: In a 2-center study of consecutive spontaneous ICH patients who underwent CTA followed by surgical hematoma evacuation, 2 experienced readers (blinded to clinical and surgical data) reviewed CTAs for spot sign presence. Blinded raters assessed active intraoperative and postoperative bleeding. The association between spot sign and active intraoperative bleeding, postoperative rebleeding, and residual ICH volumes was evaluated using univariable and multivariable logistic regression. Results: A total of 95 patients met inclusion criteria: 44 lobar, 17 deep, 33 cerebellar, and 1 brainstem ICH; ≥1 spot sign was identified in 32 patients (34%). The spot sign was the only independent marker of active bleeding during surgery (odds ratio [OR] 3.4; 95% confidence interval [CI] 1.3-9.0). Spot sign (OR 4.1; 95% CI 1.1-17), female sex (OR 6.9; 95% CI 1.7-37), and antiplatelet use (OR 4.6; 95% CI 1.2-21) were predictive of postoperative rebleeding. Larger residual hematomas and postoperative rebleeding were associated with higher discharge case fatality (OR 3.4; 95% CI 1.1-11) and a trend toward increased case fatality at 3 months (OR 2.9; 95% CI 0.9-8.8). Conclusions: The CTA spot sign is associated with more intraoperative bleeding, more postoperative rebleeding, and larger residual ICH volumes in patients undergoing hematoma evacuation for spontaneous ICH. The spot sign may therefore be useful to select patients for future surgical trials.
    Full-text · Article · Aug 2014 · Neurology
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    ABSTRACT: Background: Heparin-induced thrombocytopenia (HIT) is a dreaded complication of heparin-related products and correlates with a worse outcome in aneurysmal subarachnoid hemorrhage (SAH) patients. Objective: To study the risk factors and outcomes of SAH patients suspected of having HIT, confirmed as present or absent by the platelet factor 4 (PF4) antibody test. Methods: All patients with presumed aneurysmal, nontraumatic SAH and having undergone a PF4 test were identified through our research patient database. Charts, laboratory values and images were analyzed retrospectively. Results: We identified 166 patients with SAH who were tested for HIT; 42 patients (25%) had a positive antibody test. There was no difference in platelet profiles or mean platelet nadirs of HIT+ and HIT- patients (147 ± 93 vs. 153 ± 86 ×10(9)/l, respectively). Univariate analysis identified gender, magnesium prophylaxis, Fisher group 3, clipping versus coiling, presence of angiographic vasospasm, number of vasospasm treatments, and day of HIT testing as potential risk factors associated with HIT. A multivariate analysis indicated that female gender (OR 8.2, 95% CI 2.0-33.2), greater number of vasospasm treatments (OR 1.5, 95% CI 1.2-2.0), later day of HIT testing (OR 1.2, 95% CI 1.1-1.3), and clipping (OR 5.0, 95% CI 1.42-10.0) were independently associated with HIT positivity. HIT+ patients showed more infarcts on CT, longer ICU and hospital stays and worse modified Rankin Scale scores on discharge. Conclusion: The presence of HIT in SAH has adverse consequences and is more likely in female patients who have undergone aneurysm clipping and require multiple endovascular vasospasm treatments.
    No preview · Article · Aug 2014
  • Matthew Fusco · Ajith J Thomas · Suresh A Reddy · Christopher S Ogilvy
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    ABSTRACT: An increasing number of unruptured aneurysms are being detected as the quality and utilization of imaging modalities expands. Often these aneurysms are small and located within the cavernous or pre-communicating internal carotid artery (ICA). Treatment is typically withheld for these aneurysms and some pattern of serial follow-up imaging is undertaken via either computed tomography angiography (CTA) or magnetic resonance angiogram (MRA). It is currently not clear if either of these options provides a cost-effective method of surveillance. This study aims to quantify the price and utility of these follow-up imaging strategies.
    No preview · Article · Aug 2014 · Neurosurgery
  • S Reddy · A Thomas · M Fusco · D DiNobile · C Ogilvy
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    ABSTRACT: Onyx embolization is a well-established preoperative treatment of cerebrovascular arterio venous malformations and fistulae. We report four cases of hypervascular extraaxial tumor embolization using Onyx administration as an adjunct to traditional particle embolization and coils. We report three cases of meningioma and one case of hemangiopericytoma. These tumors are highly vascular tumor arising from the meninges, the core of the tumor predominantly supplied by the middle meningeal artery and the periphery supplied by parasatization by intracerebral branches. Hypervascular extraaxial tumor resection may cause very high volume blood loss during open surgery. Presurgical embolization of these lesions has been proven to significantly decrease intraopertaive blood loss and facilitate subsequent surgical resection. Various agents has been used in the past for embolization of these tumors including polyvinyl alcohol (PVA), gelfoam powder, gelatin microspheres, liquid adhesives and coils. For the last few decades until recently, PVA particle embolization has been the mainstay of embolization and has been widely used. Onyx is a nonpolymerizing liquid agent composed of ethylene-vinyl alcohol copolymer dissolved in dimethyl sufloxide. When injected, Onyx precipitates within vessels forming a spongy cast. We report the use of Onyx in the embolization of four cases of hypervascular extraaxial tumors. The average was 57 yrs of age and 2 males and 2 females. Technique included a guide catheter placement in the external carotid artery and a microcatheter in the distal branch of the middle meningeal artery. The guide catheter we used was a 6F Neuron catheter and the microcatheters used included marathon microcatheter and more recently a DUO catheter. A 0.38 DAC was also used in one of the cases. Advantages of Onyx embolization include a more controlled injection due to gradual precipitation in a centripetal fashion which allows for slower and more accurate injections as well as penetration of very small calibre vessels. It also has the advantages of penetrating into the branches supplied by other vascular territories. Special caution is recommended to make sure the onyx doesn't reflux into the intracerebral arteries supplying the periphery of the tumor. In the first case we did not use the particles. During embolization using Onyx, there was occlusion of the catheter with onyx at the catheter tip and Onyx wouldn't go forward and was only refluxing back and we had to abort the procedure. Although the major vessel supplying the tumor was thrombosed the tumor core itself was not embolised. In all the later cases we embolised initially with particles and then went on to complete the embolization with Onyx. This report furthers the growing body of literature confirming the safety and efficacy of Onyx in the preoperative embolization of Intracranial highly vascular extra axial tumors.
    No preview · Article · Jul 2014 · Journal of Neurointerventional Surgery
  • Robert A. Solomon · Matthew R. Fusco · Christopher S. Ogilvy

    No preview · Article · Jun 2014 · Neurosurgery
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    ABSTRACT: Purpose/Objective(s) To evaluate the obliteration rate and potential adverse effects of single-fraction proton beam stereotactic radiosurgery (PSRS) in patients with cerebral arteriovenous malformations (AVMs). Methods and Materials From 1991 to 2010, 248 consecutive patients with 254 cerebral AVMs received single-fraction PSRS at our institution. The median AVM nidus volume was 3.5 cc (range, 0.1-28.1 cc), 23% of AVMs were in critical/deep locations (basal ganglia, thalamus, or brainstem), and the most common prescription dose was 15 Gy(relative biological effectiveness [RBE]). Univariable and multivariable analyses were performed to assess factors associated with obliteration and hemorrhage. Results At a median follow-up time of 35 months (range, 6-198 months), 64.6% of AVMs were obliterated. The median time to total obliteration was 31 months (range, 6-127 months), and the 5-year and 10-year cumulative incidence of total obliteration was 70% and 91%, respectively. On univariable analysis, smaller target volume (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.86-0.93, P<.0001), smaller treatment volume (HR 0.93, 95% CI 0.90-0.96, P<.0001), higher prescription dose (HR 1.16, 95% CI 1.07-1.26, P=.001), and higher maximum dose (HR 1.14, 95% CI 1.05-1.23, P=.002) were associated with total obliteration. Deep/critical location was also associated with decreased likelihood of obliteration (HR 0.68, 95% CI 0.47-0.98, P=.04). On multivariable analysis, critical location (adjusted HR [AHR] 0.42, 95% CI 0.27-0.65, P<.001) and smaller target volume (AHR 0.81, 95% CI 0.68-0.97, P=.02) remained associated with total obliteration. Posttreatment hemorrhage occurred in 13 cases (5-year cumulative incidence of 7%), all among patients with less than total obliteration, and 3 of these events were fatal. The most common complication was seizure, controlled with medications, both acutely (8%) and in the long term (9.1%). Conclusions The current series is the largest modern series of PSRS for cerebral AVMs. PSRS can achieve a high obliteration rate with minimal morbidity. Post-treatment hemorrhage remains a potentially fatal risk among patients who have not yet responded to treatment.
    No preview · Article · Jun 2014 · International journal of radiation oncology, biology, physics

  • No preview · Article · May 2014 · Neurosurgery
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    ABSTRACT: To investigate the frequency, predictors, and clinical impact of electrographic seizures in patients with high clinical or radiologic grade non-traumatic subarachnoid hemorrhage (SAH), independent of referral bias. We compared rates of electrographic seizures and associated clinical variables and outcomes in patients with high clinical or radiologic grade non-traumatic SAH. Rates of electrographic seizure detection before and after institution of a guideline which made continuous EEG monitoring routine in this population were compared. Electrographic seizures occurred in 17.6 % of patients monitored expressly because of clinically suspected subclinical seizures. In unselected patients, seizures still occurred in 9.6 % of all cases, and in 8.6 % of cases in which there was no a priori suspicion of seizures. The first seizure detected occurred 5.4 (IQR 2.9-7.3) days after onset of subarachnoid hemorrhage with three of eight patients (37.5 %) having the first recorded seizure more than 48 h following EEG initiation, and 2/8 (25 %) at more than 72 h following EEG initiation. High clinical grade was associated with poor outcome at time of hospital discharge; electrographic seizures were not associated with poor outcome. Electrographic seizures occur at a relatively high rate in patients with non-traumatic SAH even after accounting for referral bias. The prolonged time to the first detected seizure in this cohort may reflect dynamic clinical features unique to the SAH population.
    No preview · Article · Apr 2014 · Neurocritical Care
  • Silvia Hernández-Durán · Christopher S Ogilvy
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    ABSTRACT: The purpose of this study was to present a meta-analysis on the safety and efficacy of different endovascular modalities when treating vertebral artery dissections, since ideal treatment remains controversial. We performed a meta-analysis of 39 retrospective studies involving different treatment modalities for vertebral artery dissections in adults and obtained weighted pooled proportional outcome and mortality ratios with a random effects model. Overall, 75.11 % (confidence interval (CI) 68.89–80.84, I 2 66.89 %) had excellent outcomes, 10.10 % (CI 6.83–15.56, I 2 65.64 %) had good outcomes, and 13.70 % (CI 9.64–18.35, I 2 60.33 %) had poor outcomes. Postoperative complications occurred in 10.52 % (CI 6.87–14.84, I 2 62.48 %), with 2.73 % (CI 1.64–4.10, I 2 0.0 %) exhibiting vasospasm, 3.03 % (CI 1.88–4.46, I 2 0.0 %) experiencing postoperative rebleeding, and 6.31 % (CI 3.57–9.76, I 2 60.92 %) showing ischemia. Overall mortality was 8.69 % (CI 6.13–11.64, I 2 33.76 %). When compared to these overall ratios, different treatment modality subgroups did not differ significantly, except for the proximal occlusion group, with poor outcome ratio = 26.96 % (difference 13.26, CI 0.02–30.04, p = 0.0403) and mortality ratio = 21.36 % (difference 12.67, CI 0.94–28.86, p = 0.0189). Different endovascular treatment modalities are comparatively safe and effective in the management of vertebral artery dissection. Their reduced operative time, minimal invasiveness, and overall safety render them a suitable option for intervention-amenable dissections.
    No preview · Article · Apr 2014 · Neurosurgical Review
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    ABSTRACT: Indices of the intra-aneurysm hemodynamic environment have been proposed as potentially indicative of their longitudinal outcome. To be useful, the indices need to be used to stratify large study populations and tested against known outcomes. The first objective was to compile the diverse hemodynamic indices reported in the literature. Furthermore, as morphology is often the only patient-specific information available in large population studies, the second objective was to assess how the ranking of aneurysms in a population is affected by the use of steady flow simulation as an approximation to pulsatile flow simulation, even though the former is clearly non-physiological. Sixteen indices of aneurysmal hemodynamics reported in the literature were compiled and refined where needed. It was noted that, in the literature, these global indices of flow were always time-averaged over the cardiac cycle. Steady and pulsatile flow simulations were performed on a population of 198 patient-specific and 30 idealised aneurysm models. All proposed hemodynamic indices were estimated and compared between the two simulations. It was found that steady and pulsatile flow simulations had a strong linear dependence (r ≥ 0.99 for 14 indices; r ≥ 0.97 for 2 others) and rank the aneurysms in an almost identical fashion (ρ ≥ 0.99 for 14 indices; ρ ≥ 0.96 for other 2). When geometry is the only measured piece of information available, stratification of aneurysms based on hemodynamic indices reduces to being a physically grounded substitute for stratification of aneurysms based on morphology. Under such circumstances, steady flow simulations may be just as effective as pulsatile flow simulation for estimating most key indices currently reported in the literature.
    No preview · Article · Feb 2014 · Computer Methods in Biomechanics and Biomedical Engineering
  • Pankaj K Agarwalla · Christopher J Stapleton · Christopher S Ogilvy
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    ABSTRACT: : Anterior and posterior circulation acute ischemic stroke carries significant morbidity and mortality as a result of malignant cerebral edema. Decompressive craniectomy has evolved as a viable neurosurgical intervention in the armamentarium of treatment options for this life-threatening edema. In this review, we highlight the history of craniectomy for stroke and discuss recent data relevant to its efficacy in modern neurosurgical practice. DC, decompressive craniectomyHAMLET, Hemicraniectomy After Middle Cerebral Artery infarction With Life-threatening Edema TrialICP, intracranial pressureMCA, middle cerebral arterySTATE, score, time, age, territory, and expectations.
    No preview · Article · Feb 2014 · Neurosurgery
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    ABSTRACT: Spinal artery pseudoaneurysms are rare vascular lesions with poorly defined natural history, diagnostic paradigms, and treatment strategies. We present a 68-year-old woman with severe back pain and left lower extremity weakness with spinal subarachnoid hemorrhage due to a ruptured T5 region posterior spinal artery pseudoaneurysm, and review issues related to radiologic diagnosis and endovascular and open neurosurgical interventions.
    No preview · Article · Jan 2014 · Journal of Clinical Neuroscience
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    ABSTRACT: For cerebral arteriovenous malformations (AVMs) determined to be high risk for surgery or endovascular embolization, stereotactic radiosurgery (SRS) is considered the mainstay of treatment. To determine the outcomes of pediatric patients with AVMs treated with proton SRS. We reviewed the records of 44 consecutively treated pediatric patients (age < 18) who underwent proton SRS at our institution from 1998-2010. The median target volume was 4.5±5.9 mL (range= 0.3-29.0 mL) and the median maximal diameter was 3.6± 1.5 cm (range =1-6 cm). Radiation was administered with a median prescription dose of 15.50±1.87 CGE to the 90% isodose. At a median follow-up of 52±25 months, two patients (4.5%) had no response, 24 patients (59.1%) had a partial response, and 18 patients (40.9%) experienced obliteration of their AVM. The median time to obliteration was 49±26 months, inclusive of 17 patients who underwent repeat proton radiosurgery. Four patients (9%) experienced hemorrhage following treatment at a median time of 45±15 months. Univariate analysis identified modified AVM scale score (p=0.045), single fraction treatment (0.04), larger prescription dose (0.01), larger maximum dose (<0.001), and larger minimum dose (0.01) to be associated with AVM obliteration. High-risk AVMs can be safely treated with proton radiosurgery in the pediatric population. Since protons deposit energy more selectively than photons, there is the potential benefit of protons to lower the probability of damage to healthy tissue in the developing brain.
    Full-text · Article · Jan 2014 · Neurosurgery
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    ABSTRACT: Carotid body tumors (CBT) are rare neuroendocrine neoplasms that usually present in the third or fourth decades of life and are benign in more than 95% of cases. In the angiographic literature, the arterial supply to carotid body tumors is well documented but is often incomplete, with infrequent mention of the glomic artery, a common arterial feeder described in the anatomic and pathologic literature. Through a review of our neuroendovascular patient database, we identified eight patients with CBT undergoing transarterial embolization followed by resection. Mean patient age was 51.5years (range 29-82), and all patients were female. Mean tumor size was 91.2cc (standard deviation [SD] 61.1, median 67.7cc). After embolization, greater than 90% flow reduction was achieved in 5/8 patients (63%); 60-80% flow reduction was achieved in the remaining patients. Mean operative blood loss was 166cc (SD 100, median 122cc) and mean operative time was 252minutes (SD 134.5, median 155minutes). Pre-embolization angiography was reviewed to identify a glomic artery, defined as a dominant artery supplying the CBT arising from the region of the carotid bifurcation. In six of eight patients (75%) a glomic artery could be identified, arising from the common carotid artery in 4/6 patients and the external carotid artery in 2/6 patients. Thus, glomic artery to supply to CBT was identified in the majority of patients in this series. Knowledge of its presence and identification as a direct supplier, frequently from the common carotid artery itself, provides an avenue for more thorough preoperative embolization of CBT.
    Full-text · Article · Dec 2013 · Journal of Clinical Neuroscience
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    ABSTRACT: While Onyx embolization of cerebrospinal arteriovenous shunts is well-established, clinical researchers continue to broaden applications to other vascular lesions of the neuraxis. This report illustrates the application of Onyx (eV3, Plymouth, MN) embolization to vertebral body lesions, specifically, a vertebral hemangioma and renal cell carcinoma vertebral body metastatic lesion.
    Full-text · Article · Dec 2013
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    ABSTRACT: Cerebral hyperperfusion syndrome is a well-recognized and potentially fatal complication of carotid revascularization. However, the occurrence of non-aneurysmal subarachnoid hemorrhage as a manifestation of cerebral hyperperfusion syndrome post-carotid endarterectomy is uncommon. We report a case of a patient who presented with headache following carotid endarterectomy for a critically occluded common carotid artery. This progressed to deteriorating consciousness and seizures. Investigations revealed a left cortical non-aneurysmal subarachnoid hemorrhage. Non-aneurysmal subarachnoid hemorrhage is a rare post-operative complication of carotid endarterectomy. Immediate management with aggressive blood pressure control is key to prevent permanent neurological deficits. Cerebral hyperperfusion syndrome (CHS) after carotid revascularization procedures is an uncommon and potentially fatal complication. Pathophysiologically it is attributed to impaired autoregulatory mechanisms and results in disruption of cerebral hemodynamics with increased regional cerebral blood flow (Cardiol Rev 20:84–89, 2012; J Vasc Surg 49:1060–1068, 2009). The condition is characterized by throbbing ipsilateral frontotemporal or periorbital headache. Other symptoms include vomiting, confusion, macular edema, focal motor seizures with frequent secondary generalization, focal neurological deficits, and intraparenchymal or subarachnoid hemorrhage (SAH) (Lancet Neurol 4:877–888, 2005). The incidence of CHS varies from 0.2% to 18.9% after carotid endarterectomy (CEA), with a typical reported incidence of less than 3% in larger studies (Cardiol Rev 20:84–89, 2012; Neurosurg 107:1130–1136, 2007). Uncontrolled hypertension, an arterially isolated cerebral hemisphere, and contralateral carotid occlusion are the main risk factors (Lancet Neurol 4:877–888, 2005; J Neurol Neurosurg Psychiatry 83:543–550, 2012). We present a case of non-aneurysmal SAH after CEA, with focus on its presentation, risk factors, and management.
    Preview · Article · Oct 2013 · SpringerPlus
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    ABSTRACT: Objectives: Thromboembolic complications are well recognized during the endovascular management of intracranial aneurysms. In this study, we present a case series of 40 patients with intraprocedural thrombotic complications who were treated with intra-arterial eptifibatide (IAE), and a review of the literature. Methods: Twenty-five patients with ruptured intracranial aneurysms (RIA), 10 with unruptured intracranial aneurysms (UIA) and 5 with aneurysmal subarachnoid hemorrhage-induced vasospasm (VSP) received IAE for intraprocedural thrombi during endovascular treatment. Rates of recanalization, strokes, and hemorrhagic complications were assessed. Results: Recanalization was achieved in 96% (24/25) of the RIA patients [72% (18/25) complete; 24% (6/25) partial], in 100% (10/10) of the UIA patients [90% (9/10) complete; 10% (1/10) partial], and in 100% (5/5) of the VSP patients [80% (4/5) complete; 20% (1/5) partial]. Strokes following intraprocedural thrombosis were coil-related (20%, 5/25) or stent-related (12%, 3/25) in RIA patients, stent-related (10%, 1/10) in UIA patients, and heparin-induced thrombocytopenia type II-related (60%, 3/5) or vasospasm-related (20%, 1/5) in VSP patients. There were no intracerebral hemorrhagic complications in UIA. Intracerebral hemorrhage was observed in 20% of the RIA patients (5/25), all of whom had received intra-arterial thrombolytics and/or high-dose heparin infusion in addition to IAE; in 12%, this was external ventricular drain-related (3/25), 4% had parenchymal hematoma type 1 (1/25), and 4% parenchymal hematoma type 2 (1/25). One of the 5 VSP patients, who had received argatroban in addition to IAE, had parenchymal hematoma type 1. No clinically significant systemic hemorrhage was observed in this study. Conclusion: Treatment of thromboembolic complications with IAE during endovascular management of aneurysms was effective in achieving recanalization and overall well tolerated in this series.
    No preview · Article · Oct 2013
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    ABSTRACT: Abnormal cerebral vasculature can be a manifestation of a vascular malformation or a neoplastic process. We report the case of a patient with angiography-negative subarachnoid hemorrhage (SAH) who re-presented 3 years later with a large intraparenchymal hemorrhage. Although imaging following the intraparenchymal hemorrhage was suggestive of arteriovenous malformation, the patient was ultimately found to have an extensive glioblastoma associated with abnormal tumor vasculature. The case emphasizes the need for magnetic resonance imaging to investigate angiography-negative SAH in suspicious cases to rule out occult etiologies, such as neoplasm. We also discuss diagnostic pitfalls when brain tumors are associated with hemorrhage and abnormal vasculature.
    Full-text · Article · Sep 2013 · Frontiers in Neurology
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    Adam M H Young · Surya K Karri · Christopher S Ogilvy · Ninghui Zhao
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    ABSTRACT: Moyamoya disease is a slowly progressing steno-occlusive condition affecting the cerebrovasculature. Affecting the terminal internal carotid arteries (ICA) and there branches, bilaterally, a resulting in a fine vascular network in the base of the brain to allow for compensation of the stenosed vessels. While there is obvious evidence of the involvement of inflammatory proteins in the condition, this has historically not been acknowledged as a causal factor. Here we describe the fundamental histopathology, genetics, and signaling cascades involved in moyamoya and debate whether these factors can be linked as causal factor for the condition or whether they are simply a secondary result of the ischemia described in the condition. A particular focus has been placed on the multitude of signaling cascades linked to the condition as these are viewed as having the greatest therapeutic potential. As such we hope to draw some novel insight into potential diagnostic and therapeutic inflammatory targets in the condition.
    Full-text · Article · Aug 2013 · Frontiers in Neurology

Publication Stats

8k Citations
1,203.45 Total Impact Points

Institutions

  • 2002-2015
    • Beth Israel Deaconess Medical Center
      • Division of Neurosurgery
      Boston, Massachusetts, United States
  • 1998-2015
    • Harvard University
      Cambridge, Massachusetts, United States
  • 1992-2014
    • Harvard Medical School
      • • Department of Neurology
      • • Department of Radiology
      Boston, Massachusetts, United States
    • The John B. Pierce Laboratory
      New Haven, Connecticut, United States
  • 1988-2014
    • Massachusetts General Hospital
      • • Department of Neurosurgery
      • • Department of Neurology
      • • Neurology of Vision Lab
      Boston, Massachusetts, United States
  • 2013
    • Thomas Jefferson University
      • Department of Neurological Surgery
      Philadelphia, Pennsylvania, United States
  • 2012
    • Mass General Hospital
      Boston, Massachusetts, United States
    • Partners HealthCare
      Boston, Massachusetts, United States
  • 1990-2006
    • Beverly Hospital, Boston MA
      BVY, Massachusetts, United States
  • 2003
    • Emory University
      Atlanta, Georgia, United States
  • 1996
    • Dartmouth–Hitchcock Medical Center
      LEB, New Hampshire, United States
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 1981-1988
    • Yale University
      New Haven, Connecticut, United States