15 results on '"Joshua W Osbun"'
Search Results
2. Time Line of Occlusion for Intracranial Aneurysms Treated with the Pipeline Embolization Device
- Author
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Samuel J. Cler, David C. Lauzier, Arindam R. Chatterjee, Joshua W. Osbun, Christopher J. Moran, and Akash P. Kansagra
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Treatment Outcome ,Humans ,Intracranial Aneurysm ,Stents ,Surgery ,Neurology (clinical) ,Embolization, Therapeutic ,Blood Vessel Prosthesis ,Follow-Up Studies ,Retrospective Studies - Abstract
Rates of aneurysm occlusion following treatment with flow-diverting stents have been quantified at predefined time points in clinical trials, but data characterizing the continuous temporal progression of aneurysm occlusion are lacking. This study used real-world variability in timing of angiographic follow-up to characterize the time line of aneurysm occlusion following treatment with the Pipeline embolization device (PED).All aneurysms treated with a PED at our institution between 2011 and 2020 were screened. Nonsaccular or ruptured aneurysms were excluded. Aneurysm occlusion status and time since treatment were recorded for each follow-up angiogram. Aneurysm occlusion was characterized using Kaplan-Meier and Cox proportional hazards analysis after censoring at last follow-up or subsequent treatment.There were 290 aneurysms in 222 patients analyzed. The median time of observed aneurysm occlusion was 7.5 months, and overall rate of aneurysm occlusion was 77.9%. Larger aneurysms demonstrated a longer median time to occlusion and lower rate of aneurysm occlusion (P = 0.029). There were no observed differences in the time line of occlusion for aneurysms treated with a single PED or multiple PEDs (P = 0.889) or without or with adjunctive coiling (P = 0.771).Aneurysms treated with a PED had a median time to observed occlusion of 7.5 months. Occlusion of larger aneurysms occurred more slowly than occlusion of smaller aneurysms following flow diversion. The number of PEDs deployed or the use of adjunctive coiling did not affect the time line or likelihood of aneurysm occlusion. These findings may guide optimal timing of follow-up after treatment with a PED.
- Published
- 2022
3. Mechanical Thrombectomy for Distal Occlusions: Efficacy, Functional and Safety Outcomes: Insight from the STAR Collaboration
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Nitin Goyal, Mohammad Anadani, Sami Al Kasab, Peter Kan, Richard Williamson, Christopher S. Ogilvy, Reda M. Chalhoub, Maxim Mokin, Ali Alawieh, Robert M. Starke, Brian M. Howard, Justin R Mascitelli, Kyle M Fargen, Sharon Webb, Joshua W. Osbun, Ansaar T Rai, Min S. Park, Albert J Yoo, Reade De Leacy, Alejandro M Spiotta, Shakeel A. Chowdhry, Isabel Fragata, Travis M. Dumont, Roberto Crosa, Jonathan A Grossberg, R. Webster Crowley, Charles C. Matouk, Michael R. Levitt, Ilko Maier, Marios Psychogios, Christopher P. Kellner, Pascal Jabbour, Stacey Q Wolfe, Fábio A. Nascimento, and Adam S Arthur
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Adult ,medicine.medical_specialty ,Posterior cerebral artery ,03 medical and health sciences ,0302 clinical medicine ,Modified Rankin Scale ,medicine.artery ,Occlusion ,Anterior cerebral artery ,Humans ,Medicine ,Stroke ,Aged ,Retrospective Studies ,Thrombectomy ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Middle cerebral artery ,Cohort ,Cerebral Arterial Diseases ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background Mechanical thrombectomy (MT) is the standard of care for the treatment of proximal anterior circulation large vessel occlusions. However, little is known about its efficacy and safety in the treatment of distal intracranial occlusions. Methods This is a multicenter retrospective study of patients treated with MT at 15 comprehensive centers between January 2015 and December 2018. The study cohort was divided into 2 groups based on the location of occlusion (proximal vs. distal). Distal occlusion was defined as occlusion of M3 segment of the middle cerebral artery, any segment of the anterior cerebral artery, or any segment of the posterior cerebral artery. Only isolated distal occlusion was included. Good outcome was defined as 90-day modified Rankin scale score 0–2. Results A total of 4710 patients were included in this study, of whom 189 (4%) had MT for distal occlusions. Compared with the proximal occlusion group, distal occlusion group had a higher rate of good outcome (45% vs. 36%; P = 0.03) and a lower rate of successful reperfusion (78% vs. 84%; P = 0.04). However, the differences did not retain significance in adjusted models. Otherwise there was no difference in the rate of hemorrhagic complications, mortality, or procedure-related complications between the 2 groups. Successful reperfusion, age, and admission stroke severity emerged as predictors of good functional outcome in the distal occlusion group. Conclusions Thrombectomies of distal vessels achieve high rate of successful reperfusion with similar safety profile to those in more proximal locations.
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- 2021
4. Need for Y-stenting in stent-assisted coiling of wide-neck bifurcation aneurysms
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David C. Lauzier, Brandon K. Root, Arindam R. Chatterjee, Joshua W. Osbun, Christopher J. Moran, and Akash P. Kansagra
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Surgery ,Neurology (clinical) ,General Medicine - Published
- 2023
5. Evolution of Elective Intracranial Aneurysm Treatment
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David C. Lauzier, Samuel J. Cler, Ananth K. Vellimana, Joshua W. Osbun, Arindam R. Chatterjee, Colin P. Derdeyn, Dewitte T. Cross, Christopher J. Moran, and Akash P. Kansagra
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Treatment Outcome ,Elective Surgical Procedures ,Endovascular Procedures ,Humans ,Intracranial Aneurysm ,Surgery ,Neurology (clinical) - Published
- 2022
6. Custom Shunt System for Increased Baseline Intracranial Pressure in a Patient with Idiopathic Intracranial Hypertension
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Joshua W. Osbun, Salah G. Keyrouz, Alexander T. Yahanda, Syed Hassan A. Akbari, Amar S Shah, and Carl D. Hacker
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business.industry ,Pseudotumor cerebri ,Standard treatment ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,030220 oncology & carcinogenesis ,Anesthesia ,Medicine ,Neurologic deterioration ,Surgery ,Neurology (clinical) ,Headaches ,medicine.symptom ,business ,Intracranial Hypotension ,030217 neurology & neurosurgery ,Shunt (electrical) ,Intracranial pressure - Abstract
Background Standard treatment of idiopathic intracranial hypertension (IIH) involves reduction of intracranial pressure (ICP) to normal range, often via a ventriculoperitoneal shunt (VPS). We describe a case of a middle-aged man who presented with symptoms consistent with IIH. After ICP was normalized with a VPS, the patient had neurologic deterioration into a coma. He completely recovered after a month when his ICP was allowed to increase and remain above the normal range. Case Description A 50-year-old man presented with daily headaches, visual loss (right > left), and increased lumbar opening pressure consistent with IIH. A VPS was inserted using a Strata II valve with a pressure setting of 1.5, lowering ICP into the normal range. The patient initially had a normal postoperative course, but then became comatose and developed imaging signs consistent with intracranial hypotension. A Codman Certas valve was placed at a setting of 7 and a distal slit-cut peritoneal catheter was used (as opposed to standard open output). This custom system drained at pressure >26 mm Hg based on intraoperative manometry. The patient tolerated this well and is currently planned for a gradual reduction in ICP with valve setting adjustments as an outpatient. Conclusions In patients with chronic IIH, reduction to normal ICP may unexpectedly lead to encephalopathic changes. Personalized shunts may facilitate reduction of ICP to still elevated but tolerable levels in these patients.
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- 2020
7. Impact of aneurysm morphology on safety and effectiveness of flow diverter treatment of vertebrobasilar aneurysms
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DeWitte T. Cross, Yasha Kayan, Josser E Delgado Almandoz, Adam N. Wallace, Jonathan A Grossberg, Christopher J. Moran, Joshua W. Osbun, Travis S. CreveCoeur, and Mudassar Kamran
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Aneurysm morphology ,medicine.medical_specialty ,Text mining ,Radiological and Ultrasound Technology ,business.industry ,Medicine ,Radiology, Nuclear Medicine and imaging ,Neurology (clinical) ,Radiology ,business ,Flow diverter - Published
- 2019
8. Pipeline Embolization of Vertebrobasilar Aneurysms—A Multicenter Case Series
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Adam N. Wallace, C. Michael Cawley, Akash P. Kansagra, Thomas P Madaelil, Brian M. Howard, DeWitte T. Cross, Joshua W. Osbun, Matthew J Kole, Dheeraj Gandhi, Jacques E. Dion, Mudassar Kamran, Timothy R. Miller, Josser E Delgado Almandoz, Gaurav Jindal, Anil K. Roy, Jonathan A Grossberg, Yasha Kayan, Christopher J. Moran, and Travis S. CreveCoeur
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Vertebral artery ,Fusiform Aneurysm ,medicine.disease ,Surgery ,03 medical and health sciences ,Pseudoaneurysm ,0302 clinical medicine ,Aneurysm ,030220 oncology & carcinogenesis ,medicine.artery ,Occlusion ,cardiovascular system ,medicine ,Basilar artery ,cardiovascular diseases ,Neurology (clinical) ,Embolization ,business ,Stroke ,030217 neurology & neurosurgery - Abstract
Background The Pipeline Embolization Device (PED) has been increasingly used for the treatment of posterior circulation aneurysms. The purpose of the present study was to examine the clinical and angiographic outcomes of patients with vertebrobasilar aneurysms treated with the PED. Methods We performed a retrospective review of vertebrobasilar aneurysms treated with the PED at 4 high-volume neurovascular centers. Patient, aneurysm, and procedural data were collected, including perioperative and delayed complications. Aneurysm occlusion on follow-up imaging studies was defined as complete (100%), near-complete (>90%), or incomplete ( Results The cohort included 35 patients with 37 vertebrobasilar aneurysms who underwent 36 treatment sessions. Of the 35 patients, 10 were men (29%), and the mean patient age was 54.1 years (range, 32–75). Eight patients (23%) underwent urgent treatment because of a ruptured aneurysm (n = 6), brainstem perforator stroke (n = 1), or post-traumatic pseudoaneurysm (n = 1). Of the 37 aneurysms, 22 arose from the vertebral artery (59%) and 15 from the basilar artery (41%). Also, 19 were saccular aneurysms (51%), with a mean size of 7.7 mm (range, 1.7–38.0); 17 were fusiform aneurysms (46%), with a mean size of 11.0 mm (range, 4.3–34); and 1 was a 2.9-mm blister aneurysm. The overall procedural complication rate was 14% (5 of 36), including 3 neurologically symptomatic complications. At a mean follow-up period of 14 months (range, 3–59), 24 of 34 aneurysms (71%) were completely occluded and 29 of 34 (85%) were completely or near-completely occluded. Conclusion Our results show that Pipeline embolization of vertebrobasilar aneurysms is associated with acceptable occlusion and complication rates.
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- 2019
9. Endovascular Treatment of Posterior Inferior Cerebellar Artery Aneurysms with Flow Diversion
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Christopher J. Moran, Thomas P Madaelil, Junaid T Yasin, Jonathan A Grossberg, Anil K. Roy, Yasha Kayan, Adam N. Wallace, Joshua W. Osbun, Josser E Delgado Almandoz, Mudassar Kamran, and Brian M. Howard
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Fusiform Aneurysm ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,medicine.artery ,medicine ,Humans ,cardiovascular diseases ,Pica (disorder) ,Embolization ,Vertebral Artery ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,Intracranial Aneurysm ,Middle Aged ,medicine.disease ,Neurovascular bundle ,Embolization, Therapeutic ,Cerebral Angiography ,Surgery ,Treatment Outcome ,Posterior inferior cerebellar artery ,Perforating arteries ,Angiography ,cardiovascular system ,Female ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Flow diversion is a viable alternative for treatment of wide-neck and fusiform aneurysms originating from the posterior inferior cerebellar artery (PICA), but coverage of the PICA and vertebral perforating arteries may be a concern. The aim of this study was to examine procedural, clinical, and angiographic outcomes of patients with PICA aneurysms treated with the Pipeline Embolization Device.Retrospective review was performed of PICA aneurysms treated with the Pipeline device at 3 neurovascular centers, including periprocedural complications and clinical and angiographic outcomes.In 16 procedures, 14 PICA aneurysms were treated with the Pipeline device. These included 11 saccular aneurysms with a mean size of 7.4 mm (range, 2.0-11.1 mm) and 3 fusiform aneurysms with a mean diameter of 6.1 mm (range, 5.0-8.0 mm) and mean length of 10.3 mm (range, 6.0-15.0 mm). One patient developed a PICA territory infarct with mild leg weakness that resolved in7 days. Overall complication rate was 7% (1/14) per patient and 6% (1/16) per procedure. Mean duration of clinical follow-up was 13.5 months (range, 3 weeks to 61.7 months), with all patients returning to baseline functional status. Complete or near-complete aneurysm occlusion was achieved in 58% (7/12) of cases with angiographic follow-up (mean, 15 months; range, 4-61 months). All covered PICAs remained patent.Flow diversion of PICA aneurysms is a safe and viable treatment option when traditional endovascular options are unlikely to preserve parent vessel patency.
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- 2018
10. Pipeline embolization of posterior communicating artery aneurysms associated with a fetal origin posterior cerebral artery
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Josser E Delgado Almandoz, Mudassar Kamran, Joshua W. Osbun, Adam N. Wallace, Akash P. Kansagra, Yasha Kayan, Christopher J. Moran, DeWitte T. Cross, and Matthew J. Austin
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medicine.medical_specialty ,medicine.medical_treatment ,Infarction ,Posterior cerebral artery ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,medicine.artery ,Outcome Assessment, Health Care ,Occlusion ,medicine ,Humans ,cardiovascular diseases ,Posterior communicating artery ,Embolization ,Aged ,Retrospective Studies ,Posterior Cerebral Artery ,medicine.diagnostic_test ,business.industry ,Angiography, Digital Subtraction ,Intracranial Aneurysm ,General Medicine ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Surgery ,Angiography ,cardiovascular system ,Circle of Willis ,Female ,Neurology (clinical) ,Radiology ,business ,030217 neurology & neurosurgery - Abstract
Background and purpose Flow diversion may have advantages in the treatment of posterior communicating artery (PComA) aneurysms associated with a fetal origin posterior cerebral artery (PCA), which can be challenging to treat with conventional techniques. However, a PComA incorporated into the aneurysm may prevent or delay aneurysm occlusion. Also, coverage of a fetal origin PCA risks infarction of a large vascular territory. The purpose of this study was to examine the safety and effectiveness of using the Pipeline Embolization Device (PED) to treat PComA aneurysms associated with a fetal origin PCA. Patients and methods Retrospective review of PComA aneurysms associated with a fetal origin PCA treated with the PED at two neurovascular centers was performed. Periprocedural complications and clinical and angiographic outcomes were reviewed. Results Seven female patients underwent a total of seven PED procedures to treat seven PcomA aneurysms associated with a fetal origin PCA. The symptomatic complication rate was 14% (1/7) per patient and 13% (1/8) per procedure. Angiographic follow up was obtained for 6 of 7 aneurysms. Follow-up DSA at 5–7 months after treatment demonstrated complete occlusion of 17% (1/6) of aneurysms. One aneurysm was retreated with a second PED and occlusion was demonstrated 36 months after the second treatment, yielding an overall complete occlusion rate of 33% (2/6). Conclusions PED treatment was largely ineffective at treating PComA aneurysms associated with a fetal origin PCA, and should only be considered when conventional treatment options, including microsurgical clipping, are not feasible.
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- 2017
11. Acute disseminated encephalomyelitis associated with a novel paraneoplastic process in hepatic epithelial hemangioendothelioma: A case report
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Matthew C. Loftspring, Amar S Shah, Alexander T. Yahanda, and Joshua W. Osbun
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medicine.medical_specialty ,business.industry ,Prolonged fever ,Fulminant ,General Medicine ,medicine.disease ,Malignancy ,Dermatology ,Hemangioendothelioma ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Acute disseminated encephalomyelitis ,medicine ,Surgery ,Neurology (clinical) ,Neurologic decline ,Differential diagnosis ,business ,Vasculitis ,030217 neurology & neurosurgery - Abstract
This report illustrates the case of a 23-year-old woman with fulminant acute disseminated encephalomyelitis (ADEM) in the setting of hepatic epithelial hemangioendothelioma (EHE) requiring urgent decompressive hemicraniectomy. There were no findings suggestive of infection, angionecrotic vasculitis, or neoplasm. She had no antecedent viral infection and no other signs or symptoms of previously described paraneoplastic processes. While previous cases of ADEM requiring hemicraniectomy have been reported, this is the first without antecedent viral infection or prolonged fever at onset and in the setting of this rare liver malignancy. This case supports the inclusion of ADEM in the differential diagnosis of acute neurologic decline in the absence of malignancies associated with known paraneoplastic syndromes. EHE may be associated with paraneoplastic processes requiring urgent neurosurgical intervention.
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- 2020
12. Far Lateral and Far Medial Approaches to the Foramen Magnum: Microsurgery or Endoscopy?
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Farzana Tariq, Joshua W. Osbun, and Laligam N. Sekhar
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musculoskeletal diseases ,medicine.medical_specialty ,Foramen magnum ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Vertebral artery ,Cranial nerves ,Craniocervical junction ,Anatomy ,Microsurgery ,Far lateral ,Endoscopy ,Skull ,medicine.anatomical_structure ,medicine.artery ,medicine ,Surgery ,Neurology (clinical) ,Radiology ,business - Abstract
ntradural vascular and neoplastic lesions of the skull base at the foramen magnum and the craniocervical junction area I are difficult to treat, primarily because of the complex anatomy of the area, with multiple cranial nerves, arteries and veins, and the spino-medullary junction crowded into a small area. When lesions involve the anterior or anterolateral space of the foramen magnum or the spino-medullary junction, they are more difficult to expose adequately and treat.
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- 2014
13. Radiation Dose Reduction in Neuroendovascular Procedures
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Basavaraj Ghodke, Joshua W. Osbun, Louis J. Kim, and Michael R. Levitt
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medicine.medical_specialty ,Tumor biology ,business.industry ,Radiation dose ,Medicine ,Surgery ,Medical physics ,Neurology (clinical) ,Personalized medicine ,Disease ,Intellectual property ,business - Abstract
The ability to expand and innovate on current practices, such as genetic subtyping of gliomas, personalized medicine, and stem cell research, may be impacted. On one hand, greater global access to genetic knowledge could help to disseminate neurosurgical expertise across nations. On the other hand, would these innovations continue to enjoy intellectual property protection, and if not, how would that affect progress on Parkinson disease or knowledge of central nervous system tumor biology?
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- 2013
14. Intracranial Pressure Monitoring in Severe Traumatic Brain Injury
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Michael R. Levitt, Louis J. Kim, and Joshua W. Osbun
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Text mining ,Traumatic brain injury ,business.industry ,Anesthesia ,medicine ,Intracranial pressure monitoring ,Surgery ,Neurology (clinical) ,medicine.disease ,business - Published
- 2013
15. The Pharmacogenomics of Clopidogrel
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Joshua W. Osbun, Michael R. Levitt, and Louis J. Kim
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business.industry ,Heterozygote advantage ,Drug resistance ,Pharmacology ,Clopidogrel ,Aryl Hydrocarbon Hydroxylases ,Pharmacogenomics ,medicine ,Platelet aggregation inhibitor ,Surgery ,Neurology (clinical) ,Ticlopidine ,business ,Pharmacogenetics ,medicine.drug - Published
- 2012
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