Browsing by Author "Steinberg, Gary K"

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    ItemOpen Access
    A neurovascular-unit-on-a-chip for the evaluation of the restorative potential of stem cell therapies for ischaemic stroke
    (Nature Biomedical Engineering, 2021-08) Lyu, Zhonglin; Park, Jon; Kim, Kwang-Min; Jin, Hye-Jin; Wu, Haodi; Rajadas, Jayakumar; Kim, Deok-Ho; Steinberg, Gary K; Lee, Wonjae
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    Cervical sympathectomy to treat cerebral vasospasm: a scoping review.
    (Regional anesthesia and pain medicine, 2022-11) Bombardieri, Anna Maria; Heifets, Boris D; Treggiari, Miriam; Albers, Gregory W; Steinberg, Gary K; Heit, Jeremy J

    Background/importance

    Delayed cerebral ischemia (DCI) is the second-leading cause of death and disability in patients with aneurysmal subarachnoid hemorrhage (aSAH), and is associated with cerebral arterial vasospasm (CAV). Current treatments for CAV are expensive, invasive, and have limited efficacy. Cervical sympathetic block (CSB) is an underappreciated, but potentially highly effective therapy for CAV.

    Objective

    To provide a comprehensive review of the preclinical and human literature pertinent to CSB in the context of CAV.

    Evidence review

    This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. We conducted a literature search using Embase, PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus and Web of Science until February 2022, to identify abstracts, conference proceedings, and full-text papers pertinent to cervical sympathectomy and CAV in animal/adult patients.

    Findings

    We included six human and six experimental studies. Human studies were mostly prospective observational, except one retrospective and one randomized clinical trial, and used various imaging modalities to measure changes in arterial diameter after the block. Studies that used digital subtraction angiography showed an improvement in cerebral perfusion without change in vessel diameter. Transcranial Doppler studies found an approximately 15% statistically significant decrease in velocities consistent with arterial vasodilatation. Overall, the results suggest an increase in cerebral arterial diameter and neurological improvement in patients receiving a CSB. Animal studies demonstrate that sympathetic system ablation vasodilates cerebral vasculature and decreases the incidence of symptomatic vasospasm.

    Conclusions

    This scoping review suggests that CSB may be a viable option for treatment and prevention of CAV/DCI in patients with aSAH, although the included studies were heterogeneous, mostly observational, and with a small sample size. Further research is needed to standardize the technique and prove its effectiveness to treat patients suffering of CAV/DCI after aSAH.
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    Intracranial Artery Morphology in Pediatric Moya Moya Disease and Moya Moya Syndrome.
    (Neurosurgery, 2022-11) Yedavalli, Vivek S; Quon, Jennifer L; Tong, Elizabeth; van Staalduinen, Eric K; Mouches, Pauline; Kim, Lily H; Steinberg, Gary K; Grant, Gerald A; Yeom, Kristen W; Forkert, Nils D

    Background

    Moya Moya disease (MMD) and Moya Moya syndrome (MMS) are cerebrovascular disorders, which affect the internal carotid arteries (ICAs). Diagnosis and surveillance of MMD/MMS in children mostly rely on qualitative evaluation of vascular imaging, especially MR angiography (MRA).

    Objective

    To quantitatively characterize arterial differences in pediatric patients with MMD/MMS compared with normal controls.

    Methods

    MRA data sets from 17 presurgery MMD/MMS (10M/7F, mean age = 10.0 years) patients were retrospectively collected and compared with MRA data sets of 98 children with normal vessel morphology (49 male patients; mean age = 10.6 years). Using a level set segmentation method with anisotropic energy weights, the cerebral arteries were automatically extracted and used to compute the radius of the ICA, middle cerebral artery (MCA), anterior cerebral artery (ACA), posterior cerebral artery (PCA), and basilar artery (BA). Moreover, the density and the average radius of all arteries in the MCA, ACA, and PCA flow territories were quantified.

    Results

    Statistical analysis revealed significant differences comparing children with MMD/MMS and those with normal vasculature ( P < .001), whereas post hoc analyses identified significantly smaller radii of the ICA, MCA-M1, MCA-M2, and ACA ( P < .001) in the MMD/MMS group. No significant differences were found for the radii of the PCA and BA or any artery density and average artery radius measurement in the flow territories ( P > .05).

    Conclusion

    His study describes the results of an automatic approach for quantitative characterization of the cerebrovascular system in patients with MMD/MMS with promising preliminary results for quantitative surveillance in pediatric MMD/MMS management.