Neurosurgery News December 2016

In this issue of Neurosurgery News, Drs. Bradley Gross, Ashutosh Jadhav, Tudor Jovin, Brian Jankowitz, and Phillip V. Parry discuss topics including stent-assisted aneurysm coiling, dural arteriovenous fistulas, extending the role of the neuroendovascular surgeon in a deployed environment, and improving outcomes in the acute stroke population with endovascular therapy.

Educational objectives:

Upon completion of this activity, participants should be able to:

• Recognize the rationale for the usage of stents to assist coiling of intracranial aneurysms.
• Identify some of the limitations of first generation intracranial stent technology and how the new ATLAS stent may overcome some of them.
• Recognize treatment options and overall results for dural arteriovenous fistulas.
• Review presentation modalities for dural arteriovenous fistulas.
• Identify risk factors for an aggressive course for dural arteriovenous fistulas.
• Improve civilian understanding about Neurosurgical capabilities in a deployed environment.
• Increase patient outcomes by implementing peripheral vascular procedures that can be safely performed by someone with a basic endovascular skill set.
• Improve diagnostic skill set for being able to identify cerebrovascular pathology.
• Closely follow recommended guidelines by referring patients for endovascular therapy with acute ischemic stroke in the setting of large vessel occlusive disease.
• Increase patient outcomes by considering IV thrombolysis for patients presenting within 4. 5 hours of symptoms onset after acute ischemic stroke
• Improve management of acute ischemic stroke in order to maximize the number of patients that will benefit from available therapies.

Reading Resources:

1. Ragel BT et al. Neurosurgery in Afghanistan during "Operation Enduring Freedom": a 24-month experience. Neurosurg Focus. 2010 May;28(5):E8.
2. Klimo P Jr et al. Can surgery improve neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons. Neurosurg Focus. 2010 May;28(5):E4
3. Rosenfeld JV et al. Current concepts in penetrating and blast injury to the central nervous system. World J Surg. 2015 Jun;39(6):1352-62. 
4. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, Johnston KC, Johnston SC, Khalessi AA, Kidwell CS, Meschia JF, Ovbiagele B, Yavagal DR; American Heart Association Stroke Council.  2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.  Stroke. 2015 Oct;46(10):3020-35.
5. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, Dávalos A, Majoie CB, van der Lugt A, de Miquel MA, Donnan GA, Roos YB, Bonafe A, Jahan R, Diener HC, van den Berg LA, Levy EI, Berkhemer OA, Pereira VM, Rempel J, Millán M, Davis SM, Roy D, Thornton J, Román LS, Ribó M, Beumer D, Stouch B, Brown S, Campbell BC, van Oostenbrugge RJ, Saver JL, Hill MD, Jovin TG; HERMES collaborators.  Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials.  Lancet. 2016 Apr 23;387(10029):1723-31.
6. Jovin TG, Liebeskind DS, Gupta R, Rymer M, Rai A, Zaidat OO, Abou-Chebl A, Baxter B, Levy EI, Barreto A, Nogueira RG.  Imaging-based endovascular therapy for acute ischemic stroke due to proximal intracranial anterior circulation occlusion treated beyond 8 hours from time last seen well: retrospective multicenter analysis of 237 consecutive patients.  Stroke. 2011 Aug;42(8):2206-11.

Disclosures:

Drs. Gross, Jadhav, Jankowitz, and Parry have reported no relationships with any entities producing health care goods or services.

Dr. Jovin has financial interests with the following any entity or entities producing health care goods or services as indicated below:

Consultant: Codman Neurovascular, Neuravi

Stockholder: Silk Road, Anaconda

All presenters disclosure of relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients is listed above.  No other planners, members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships to disclose.

Accreditation Statement:

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits™. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (0.05) continuing education units (CEU) which are equivalent to .5 contact hour.

For your credit transcript, please access our website 4 weeks post-completion at http://ccehs.upmc.edu and follow the link to the Credit Transcript page. If you do not provide the last 5 digits of your SSN on the next page you will not be able to access a CME credit transcript. Providing your SSN is voluntary.

Release Date: 12/21/2016 | Last Modified On: 12/21/2016 | Expires: 12/21/17