Hyman Newman Institute for Neurology and Neurosurgery

New York City, NY, United States

Hyman Newman Institute for Neurology and Neurosurgery

New York City, NY, United States
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Georges R.,0 rue Worth | Luc P.,Center Hospitalier Of Nancy | Alex B.,Hyman Newman Institute for Neurology and Neurosurgery | Alessandra B.,CHU Jean Minjoz | And 19 more authors.
Interventional Neuroradiology | Year: 2013

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 anatomoclinical 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.


Fifi J.T.,Hyman Newman Institute for Neurology and Neurosurgery | Brockington C.,St Lukes Roosevelt Hospital Center | Narang J.,St Lukes Roosevelt Hospital Center | Leesch W.,Hyman Newman Institute for Neurology and Neurosurgery | And 4 more authors.
American Journal of Neuroradiology | Year: 2013

BACKGROUND AND PURPOSE: Antiplatelet drug resistance has been associated with thromboembolic complications in patients after coronary stent placement. It has not been well-studied in patients who have neurovascular stent-placement procedures. This study aimed to analyze the relationship between antiplatelet drug resistance and neurovascular stent-placement complications. MATERIALS AND METHODS: A prospective data base of all patients treated at our institution was used to identify patients with neurovascular stent-placement procedures. During a 4.5-year period, all patients undergoing neurovascular stent placement were evaluated for aspirin and clopidogrel resistance by using the VerifyNow assay. During an observational phase, all patients received 75 mg of clopidogrel and aspirin (group A). During the intervention phase (group B), patients were given additional clopidogrel on the basis of the clopidogrel resistance assay.Weassessed the development of thromboembolic complications within 30 days of the procedure in patients who were resistant-versus-nonresistant to clopidogrel. RESULTS: Of 96 patients who had neurovascular stent placement, 5.2% were resistant to aspirin and 36.5% were resistant to clopidogrel. Periprocedural thromboembolic complications were seen in 7 patients (7.3%). In a multivariate logistic regression model, clopidogrel resistance, higher diastolic blood pressure, and lack of statin use were significantly associated with periprocedural thromboembolic complication. There was a nonsignificant decrease in thromboembolic complications in patients whose clopidogrel dosage was tailored to the assay. CONCLUSIONS: In our series, clopidogrel resistance was associated with increased periprocedural thromboembolic complications from neurovascular stent-placement procedures. Targeting the clopidogrel dose to platelet inhibition assays may improve clinical outcomes and requires further study.


Paramasivam S.,St Lukes Roosevelt Hospital | Paramasivam S.,Hyman Newman Institute for Neurology and Neurosurgery | Niimi Y.,St Lukes Roosevelt Hospital | Meila D.,Klinikum Duisburg Sana Kliniken | Berenstein A.,St Lukes Roosevelt Hospital
Interventional Neuroradiology | Year: 2014

Dural arteriovenous fistulas (DAVF) associated with our series of patients with vein of Galen malformations (VOGM) are analyzed and discussed. We retrospectively analyzed 87 consecutive cases of VOGM treated between May 2002 and December 2011 and identified 26 patients with DAVF. We gathered information from the clinical case records, angiographic images, MRI on presentation and during follow-up. The findings were analyzed to aid discussion. Among 87 patients treated by multi-stage endovascular embolization, age range from newborn to 19 years, 26(30%) had DAVF. In seven patients (8%), DAVF were found on initial angiogram and were all into the VOGM. Nineteen (21%) DAVF found on follow-up angiograms were all into the VOGM and distant locations. Sprouting and non-sprouting angiogenesis resulted in the formation of a network of vessels around partially thrombosed VOGM, recruiting blood from the surrounding dura mater resulting in a secondary network on the dura mater supplied by the blood vessels of dura mater in the region or from its natural collaterals. Embolization targeting DAVFs was done in 13 (52%) with complete cure in eight (32%) and recurrence in five (20%). Among 12 non-embolized patients (48%), eight (32%) had spontaneous regression with continued treatment of VOGM. In others, the DAVF either remained stable or progressed. DAVF associated with VOGM represent the dural response to angiogenic stimuli. They are observed to regress spontaneously or mature while continuing to treat the primary feeders of VOGM. It is important to include the external carotid system during angiograms. Persistent DAVF with residual VOGM that do not have access though the pial vessels are used as a conduit to treat the dural shunt and to achieve obliteration of residual VOGM at later stages of treatment.


PubMed | Hyman Newman Institute for Neurology and Neurosurgery
Type: | Journal: Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences | Year: 2010

The purpose of this study is to evaluate efficacy and reliability of chemical provocative testing using neurophysiological monitoring prior to embolization of spinal cord AVMs (SCAVMs). We performed retrospective analysis of provocative testing using sodium amytal and lidocaine injected superselectively in 41 angiography and/or embolization procedures in 26 patients with a SCAVM, including 23 amytal and 26 lidocaine injections.All procedures were performed under general anesthesia using neuroleptic drugs, and with monitoring of cortical somatosensory evoked potentials (SEPs) and trans-cranial motor evoked potentials (MEPs). After recording baseline SEPs and MEPs, 50mg of sodium amytal was injected through the microcatheter at the position of the intended embolization, followed by assessment of SEPs and MEPs. If no changes occurred, 40mg of lidocaine was then injected followed by recording of SEPs and MEPs. If again no changes were noted, embolization was performed using NBCA. If there was any change in either SEPs or MEPs, NBCA embolization was not performed from that catheter position. No false negative results of the provocative testing were experienced. One amytal test from the posterior spinal artery (PSA) was positive, causing loss of MEPs. Lidocaine testing was positive in 10 cases including 4 injections in the PSA (with loss of MEPs in two and SEPs in two), 5 injections in the anterior spinal artery (with loss of MEPs in four and SEPs in one), and 1 case involving the posterior inferior cerebellar artery (with loss of MEPs). Neither amytal nor lidocaine injection caused loss of both SEPs and MEPs. In conclusion, sodium amytal and lidocaine are complimentary as pharmacological agents for provocative testing, and SEPs and MEPs are complimentary to each other as physiologic monitoring methods. Provocative testing should be performed using both amytal and lidocaine with monitoring of both SEPs and MEPs.


PubMed | Hyman Newman Institute for Neurology and Neurosurgery
Type: | Journal: Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences | Year: 2010

The purpose of this study is to evaluate the symptoms, anatomy and efficacy of embolization of spinal cord AVMs (SCAVMs). We performed retrospective analysis of 108 SCAVMs consisting of 38 pediatric and 70 adult cases. They included 81 nidus (26 pediatric) and 27 fistulous (12 pediatric) AVMs. Hemorrhage occurred in 74% of pediatric and 62% of adult cases with multiple hemorrhages in 54% of pediatric and 42% of adult cases. Fistulous AVMs hemorrhaged more frequently in children than adults (75% vs. 13%). 75 cases were treated with embolization alone, 10 with surgery and embolization , 2 with embolization following radiation and 12 with surgery alone. 9 patients received no treatment. In 79 of 87 embolized patients, acrylic was utilized either alone (49) or in combination (30) with other materials. Embolization was attempted 156 times in 93 patients. Complete obliteration by embolization was obtained in 17 cases. If complete obliteration was not possible, partial targeted embolization was performed, aiming at dangerous anatomic structures such as aneurysms. During the follow-up period (mean: 34 months), hemorrhage was observed in only 2 cases. Although technical complications such as dissection or vasospasm occurred on 19 occasions, only 4 resulted in aggravation of neurological symptoms. Of the 21 sessions in which worsening of symptoms occurred after embolization, 10 resulted in permanent deficits and eight of these occurred prior to 1990. SCAVMs have a poor functional prognosis due to frequent hemorrhage if untreated. Embolization with acrylic is feasible as the first choice of treatment. Provocative test and electrophysiological monitoring have improved safety. Partial targeted embolization is effective in preventing hemorrhage.

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