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Parthasarathy D Thirumala – One of the best experts on this subject based on the ideXlab platform.

  • diagnostic accuracy of somatosensory evoked potentials during intracranial Aneurysm Clipping for perioperative stroke
    Journal of Clinical Monitoring and Computing, 2020
    Co-Authors: Ahmed Kashkoush, Donald J Crammond, Jeffrey R Balzer, Miguel Habeych, Christopher Nguyen, Parthasarathy D Thirumala
    Abstract:

    Somatosensory evoked potentials (SSEPs) are utilized during Aneurysm Clipping to detect intraoperative ischemia. We assess the diagnostic accuracy of SSEPs in predicting perioperative stroke during Aneurysm Clipping. A retrospective review was conducted of 429 consecutive patients who underwent surgical Clipping for ruptured and unruptured cerebral Aneurysms with intraoperative SSEP monitoring from 2006 to 2013. The relationship between perioperative stroke and SSEP changes was analyzed by calculating the sensitivity, specificity, and area under a Receiving Operating Characteristic curve. Sensitivity and specificity were 42% and 90%, respectively. Area under the curve was 0.66 (95% confidence interval, 0.53–0.79). Reclassification of reversible temporary clip changes to correct for paradoxical classification of SSEP false positives raised the sensitivity from 42 to 65% (p = 0.041, Chi squared test). EEG (electroencephalography) changes increased the specificity (98% vs. 90%, p < 0.001, McNemar’s test), but not sensitivity (48% vs. 42%, p = 0.621, McNemar’s test) of SSEPs for perioperative stroke. A stepwise logistic regression model selected SSEP amplitude loss (p = 0.006, OR = 3.7 [95% CI 1.5–9.2]) and the SSEP change duration (p = 0.034, OR = 1.8 [95% CI 1.1–3.1]) as independent predictors of perioperative stroke. SSEP changes induced by temporary Clipping were highly reversible compared to other SSEP changes (94% vs. 60%, p = 0.003, Fisher exact test), and typically responded to clip removal or readjustment. SSEP changes have high specificity and modest sensitivity for perioperative stroke. Stroke risk is a function of both the magnitude of SSEP amplitude loss and the duration of its loss. Given the modest sensitivity, patients may benefit from multimodal monitoring including motor-evoked potentials during cerebral Aneurysm surgery.

  • Diagnostic accuracy of somatosensory evoked potentials during intracranial Aneurysm Clipping for perioperative stroke
    Journal of Clinical Monitoring and Computing, 2019
    Co-Authors: Ahmed Kashkoush, Jeffrey Balzer, Donald J Crammond, Miguel Habeych, Christopher Nguyen, Parthasarathy D Thirumala
    Abstract:

    Somatosensory evoked potentials (SSEPs) are utilized during Aneurysm Clipping to detect intraoperative ischemia. We assess the diagnostic accuracy of SSEPs in predicting perioperative stroke during Aneurysm Clipping. A retrospective review was conducted of 429 consecutive patients who underwent surgical Clipping for ruptured and unruptured cerebral Aneurysms with intraoperative SSEP monitoring from 2006 to 2013. The relationship between perioperative stroke and SSEP changes was analyzed by calculating the sensitivity, specificity, and area under a Receiving Operating Characteristic curve. Sensitivity and specificity were 42% and 90%, respectively. Area under the curve was 0.66 (95% confidence interval, 0.53–0.79). Reclassification of reversible temporary clip changes to correct for paradoxical classification of SSEP false positives raised the sensitivity from 42 to 65% (p = 0.041, Chi squared test). EEG (electroencephalography) changes increased the specificity (98% vs. 90%, p 

  • diagnostic value of somatosensory evoked potential monitoring during cerebral Aneurysm Clipping a systematic review
    World Neurosurgery, 2016
    Co-Authors: Parthasarathy D Thirumala, Reshmi Udesh, Aditya Muralidharan, Karthy Thiagarajan, Donald J Crammond, Yuefang Chang, Jeffrey Balzer
    Abstract:

    Background Perioperative stroke is a known complication in patients undergoing surgical Clipping of cerebral Aneurysms. Objective To evaluate whether intraoperative changes in somatosensory-evoked potential (SSEP) monitoring during cerebral Aneurysm Clipping is diagnostic of perioperative stroke. Methods An electronic search of PubMed, Embase, and Web of Science databases was done for studies published through May 2015 on SSEP monitoring in cerebral Aneurysm Clipping for predicting postoperative outcomes. All titles and abstracts were screened independently on the basis of predetermined criteria. Inclusion criteria included randomized clinical trials and prospective or retrospective cohort reviews; patients with intracranial Aneurysms who underwent surgical Clipping with intra-operative SSEP monitoring and postoperative neurologic assessment; studies published in English on adult humans ≥18 years with sample size of ≥50; and studies inclusive of an abstract with adequate details on outcomes. Results A total of 14 articles with a sample population of 2015 patients were analyzed. SSEP monitoring demonstrated a strong mean specificity of 84.5% (95% confidence interval [95% CI] −76.3 to 90.3) but weaker sensitivity of 56.8% (95% CI 44.1−68.6) for predicting stroke. A diagnostic odds ratio of 7.772 (95% CI 5.133−11.767) suggested that the odds of observing an SSEP change among those with a postoperative neurologic deficit were 7 times greater than those without a neurologic deficit. Conclusion Intraoperative SSEP monitoring is highly specific for predicting neurologic outcome after cerebral Aneurysm Clipping. Patients with postoperative neurologic deficits are 7 times more likely to have had intraoperative SSEP changes. SSEP monitoring may help design prevention strategies to reduce stroke rates after cerebral Aneurysm Clipping.

Donald J Crammond – One of the best experts on this subject based on the ideXlab platform.

  • diagnostic accuracy of somatosensory evoked potentials during intracranial Aneurysm Clipping for perioperative stroke
    Journal of Clinical Monitoring and Computing, 2020
    Co-Authors: Ahmed Kashkoush, Donald J Crammond, Jeffrey R Balzer, Miguel Habeych, Christopher Nguyen, Parthasarathy D Thirumala
    Abstract:

    Somatosensory evoked potentials (SSEPs) are utilized during Aneurysm Clipping to detect intraoperative ischemia. We assess the diagnostic accuracy of SSEPs in predicting perioperative stroke during Aneurysm Clipping. A retrospective review was conducted of 429 consecutive patients who underwent surgical Clipping for ruptured and unruptured cerebral Aneurysms with intraoperative SSEP monitoring from 2006 to 2013. The relationship between perioperative stroke and SSEP changes was analyzed by calculating the sensitivity, specificity, and area under a Receiving Operating Characteristic curve. Sensitivity and specificity were 42% and 90%, respectively. Area under the curve was 0.66 (95% confidence interval, 0.53–0.79). Reclassification of reversible temporary clip changes to correct for paradoxical classification of SSEP false positives raised the sensitivity from 42 to 65% (p = 0.041, Chi squared test). EEG (electroencephalography) changes increased the specificity (98% vs. 90%, p < 0.001, McNemar’s test), but not sensitivity (48% vs. 42%, p = 0.621, McNemar’s test) of SSEPs for perioperative stroke. A stepwise logistic regression model selected SSEP amplitude loss (p = 0.006, OR = 3.7 [95% CI 1.5–9.2]) and the SSEP change duration (p = 0.034, OR = 1.8 [95% CI 1.1–3.1]) as independent predictors of perioperative stroke. SSEP changes induced by temporary Clipping were highly reversible compared to other SSEP changes (94% vs. 60%, p = 0.003, Fisher exact test), and typically responded to clip removal or readjustment. SSEP changes have high specificity and modest sensitivity for perioperative stroke. Stroke risk is a function of both the magnitude of SSEP amplitude loss and the duration of its loss. Given the modest sensitivity, patients may benefit from multimodal monitoring including motor-evoked potentials during cerebral Aneurysm surgery.

  • Diagnostic accuracy of somatosensory evoked potentials during intracranial Aneurysm Clipping for perioperative stroke
    Journal of Clinical Monitoring and Computing, 2019
    Co-Authors: Ahmed Kashkoush, Jeffrey Balzer, Donald J Crammond, Miguel Habeych, Christopher Nguyen, Parthasarathy D Thirumala
    Abstract:

    Somatosensory evoked potentials (SSEPs) are utilized during Aneurysm Clipping to detect intraoperative ischemia. We assess the diagnostic accuracy of SSEPs in predicting perioperative stroke during Aneurysm Clipping. A retrospective review was conducted of 429 consecutive patients who underwent surgical Clipping for ruptured and unruptured cerebral Aneurysms with intraoperative SSEP monitoring from 2006 to 2013. The relationship between perioperative stroke and SSEP changes was analyzed by calculating the sensitivity, specificity, and area under a Receiving Operating Characteristic curve. Sensitivity and specificity were 42% and 90%, respectively. Area under the curve was 0.66 (95% confidence interval, 0.53–0.79). Reclassification of reversible temporary clip changes to correct for paradoxical classification of SSEP false positives raised the sensitivity from 42 to 65% (p = 0.041, Chi squared test). EEG (electroencephalography) changes increased the specificity (98% vs. 90%, p 

  • perioperative stroke after cerebral Aneurysm Clipping risk factors and postoperative impact
    Journal of Clinical Neuroscience, 2017
    Co-Authors: Ahmed Kashkoush, Donald J Crammond, Yuefang Chang, Brian T Jankowitz, Chris Nguyen, Paul A Gardner, Daniel A Wecht, Robert M Friedlander, Miguel Habeych, Jeffrey R Balzer
    Abstract:

    Abstract Stroke is a devastating complication after intracranial Aneurysm Clipping. Understanding the risk factors that prognosticate perioperative stroke may help to identify patients that would benefit from neuroprotective therapy. This study assesses patient-specific independent predictors of perioperative stroke in relation to surgical Aneurysm Clipping. Additionally, this study evaluates the postoperative complications of stroke. We performed a retrospective chart review of 437 patients with ruptured and unruptured intracranial Aneurysms, which underwent surgical Clipping from 2006 to 2013. Multivariate logistical regression was utilized to assess the effect of age, race, gender, subarachnoid hemorrhage, Hunt and Hess (H/H) grade, Aneurysm location, and intraoperative somatosensory evoked potentials (SSEPs) changes on the frequency of perioperative stroke. Thirty-five (8.0%) patients developed a stroke within 24 h postoperatively. Patients with significant intraoperative SSEP changes were 7.33 (95% confidence interval [CI]: 3.51–15.31) times more likely to develop perioperative strokes. In patients who presented with H/H grade 5, the odds ratio for developing perioperative stroke was 9.21 (95% CI: 1.28–66.13) respectively. In the absence of Aneurysm rupture, patients presenting with new-onset stroke were more likely to suffer postoperative complications, stay in the intensive care unit longer, and be discharged to in-patient rehabilitation compared to patients without new-onset stroke. This study suggests that severity of subarachnoid hemorrhage based on the patient’s clinical condition increases the risk of perioperative stroke in patients with surgical Aneurysm Clipping. SSEP changes and high-grade H/H scores can serve as independent predictors of perioperative stroke, with the latter having the greatest predictive value.

Jeffrey Balzer – One of the best experts on this subject based on the ideXlab platform.

  • Diagnostic accuracy of somatosensory evoked potentials during intracranial Aneurysm Clipping for perioperative stroke
    Journal of Clinical Monitoring and Computing, 2019
    Co-Authors: Ahmed Kashkoush, Jeffrey Balzer, Donald J Crammond, Miguel Habeych, Christopher Nguyen, Parthasarathy D Thirumala
    Abstract:

    Somatosensory evoked potentials (SSEPs) are utilized during Aneurysm Clipping to detect intraoperative ischemia. We assess the diagnostic accuracy of SSEPs in predicting perioperative stroke during Aneurysm Clipping. A retrospective review was conducted of 429 consecutive patients who underwent surgical Clipping for ruptured and unruptured cerebral Aneurysms with intraoperative SSEP monitoring from 2006 to 2013. The relationship between perioperative stroke and SSEP changes was analyzed by calculating the sensitivity, specificity, and area under a Receiving Operating Characteristic curve. Sensitivity and specificity were 42% and 90%, respectively. Area under the curve was 0.66 (95% confidence interval, 0.53–0.79). Reclassification of reversible temporary clip changes to correct for paradoxical classification of SSEP false positives raised the sensitivity from 42 to 65% (p = 0.041, Chi squared test). EEG (electroencephalography) changes increased the specificity (98% vs. 90%, p 

  • diagnostic value of somatosensory evoked potential monitoring during cerebral Aneurysm Clipping a systematic review
    World Neurosurgery, 2016
    Co-Authors: Parthasarathy D Thirumala, Reshmi Udesh, Aditya Muralidharan, Karthy Thiagarajan, Donald J Crammond, Yuefang Chang, Jeffrey Balzer
    Abstract:

    Background Perioperative stroke is a known complication in patients undergoing surgical Clipping of cerebral Aneurysms. Objective To evaluate whether intraoperative changes in somatosensory-evoked potential (SSEP) monitoring during cerebral Aneurysm Clipping is diagnostic of perioperative stroke. Methods An electronic search of PubMed, Embase, and Web of Science databases was done for studies published through May 2015 on SSEP monitoring in cerebral Aneurysm Clipping for predicting postoperative outcomes. All titles and abstracts were screened independently on the basis of predetermined criteria. Inclusion criteria included randomized clinical trials and prospective or retrospective cohort reviews; patients with intracranial Aneurysms who underwent surgical Clipping with intra-operative SSEP monitoring and postoperative neurologic assessment; studies published in English on adult humans ≥18 years with sample size of ≥50; and studies inclusive of an abstract with adequate details on outcomes. Results A total of 14 articles with a sample population of 2015 patients were analyzed. SSEP monitoring demonstrated a strong mean specificity of 84.5% (95% confidence interval [95% CI] −76.3 to 90.3) but weaker sensitivity of 56.8% (95% CI 44.1−68.6) for predicting stroke. A diagnostic odds ratio of 7.772 (95% CI 5.133−11.767) suggested that the odds of observing an SSEP change among those with a postoperative neurologic deficit were 7 times greater than those without a neurologic deficit. Conclusion Intraoperative SSEP monitoring is highly specific for predicting neurologic outcome after cerebral Aneurysm Clipping. Patients with postoperative neurologic deficits are 7 times more likely to have had intraoperative SSEP changes. SSEP monitoring may help design prevention strategies to reduce stroke rates after cerebral Aneurysm Clipping.

Ahmed Kashkoush – One of the best experts on this subject based on the ideXlab platform.

  • diagnostic accuracy of somatosensory evoked potentials during intracranial Aneurysm Clipping for perioperative stroke
    Journal of Clinical Monitoring and Computing, 2020
    Co-Authors: Ahmed Kashkoush, Donald J Crammond, Jeffrey R Balzer, Miguel Habeych, Christopher Nguyen, Parthasarathy D Thirumala
    Abstract:

    Somatosensory evoked potentials (SSEPs) are utilized during Aneurysm Clipping to detect intraoperative ischemia. We assess the diagnostic accuracy of SSEPs in predicting perioperative stroke during Aneurysm Clipping. A retrospective review was conducted of 429 consecutive patients who underwent surgical Clipping for ruptured and unruptured cerebral Aneurysms with intraoperative SSEP monitoring from 2006 to 2013. The relationship between perioperative stroke and SSEP changes was analyzed by calculating the sensitivity, specificity, and area under a Receiving Operating Characteristic curve. Sensitivity and specificity were 42% and 90%, respectively. Area under the curve was 0.66 (95% confidence interval, 0.53–0.79). Reclassification of reversible temporary clip changes to correct for paradoxical classification of SSEP false positives raised the sensitivity from 42 to 65% (p = 0.041, Chi squared test). EEG (electroencephalography) changes increased the specificity (98% vs. 90%, p < 0.001, McNemar’s test), but not sensitivity (48% vs. 42%, p = 0.621, McNemar’s test) of SSEPs for perioperative stroke. A stepwise logistic regression model selected SSEP amplitude loss (p = 0.006, OR = 3.7 [95% CI 1.5–9.2]) and the SSEP change duration (p = 0.034, OR = 1.8 [95% CI 1.1–3.1]) as independent predictors of perioperative stroke. SSEP changes induced by temporary Clipping were highly reversible compared to other SSEP changes (94% vs. 60%, p = 0.003, Fisher exact test), and typically responded to clip removal or readjustment. SSEP changes have high specificity and modest sensitivity for perioperative stroke. Stroke risk is a function of both the magnitude of SSEP amplitude loss and the duration of its loss. Given the modest sensitivity, patients may benefit from multimodal monitoring including motor-evoked potentials during cerebral Aneurysm surgery.

  • Diagnostic accuracy of somatosensory evoked potentials during intracranial Aneurysm Clipping for perioperative stroke
    Journal of Clinical Monitoring and Computing, 2019
    Co-Authors: Ahmed Kashkoush, Jeffrey Balzer, Donald J Crammond, Miguel Habeych, Christopher Nguyen, Parthasarathy D Thirumala
    Abstract:

    Somatosensory evoked potentials (SSEPs) are utilized during Aneurysm Clipping to detect intraoperative ischemia. We assess the diagnostic accuracy of SSEPs in predicting perioperative stroke during Aneurysm Clipping. A retrospective review was conducted of 429 consecutive patients who underwent surgical Clipping for ruptured and unruptured cerebral Aneurysms with intraoperative SSEP monitoring from 2006 to 2013. The relationship between perioperative stroke and SSEP changes was analyzed by calculating the sensitivity, specificity, and area under a Receiving Operating Characteristic curve. Sensitivity and specificity were 42% and 90%, respectively. Area under the curve was 0.66 (95% confidence interval, 0.53–0.79). Reclassification of reversible temporary clip changes to correct for paradoxical classification of SSEP false positives raised the sensitivity from 42 to 65% (p = 0.041, Chi squared test). EEG (electroencephalography) changes increased the specificity (98% vs. 90%, p 

  • perioperative stroke after cerebral Aneurysm Clipping risk factors and postoperative impact
    Journal of Clinical Neuroscience, 2017
    Co-Authors: Ahmed Kashkoush, Donald J Crammond, Yuefang Chang, Brian T Jankowitz, Chris Nguyen, Paul A Gardner, Daniel A Wecht, Robert M Friedlander, Miguel Habeych, Jeffrey R Balzer
    Abstract:

    Abstract Stroke is a devastating complication after intracranial Aneurysm Clipping. Understanding the risk factors that prognosticate perioperative stroke may help to identify patients that would benefit from neuroprotective therapy. This study assesses patient-specific independent predictors of perioperative stroke in relation to surgical Aneurysm Clipping. Additionally, this study evaluates the postoperative complications of stroke. We performed a retrospective chart review of 437 patients with ruptured and unruptured intracranial Aneurysms, which underwent surgical Clipping from 2006 to 2013. Multivariate logistical regression was utilized to assess the effect of age, race, gender, subarachnoid hemorrhage, Hunt and Hess (H/H) grade, Aneurysm location, and intraoperative somatosensory evoked potentials (SSEPs) changes on the frequency of perioperative stroke. Thirty-five (8.0%) patients developed a stroke within 24 h postoperatively. Patients with significant intraoperative SSEP changes were 7.33 (95% confidence interval [CI]: 3.51–15.31) times more likely to develop perioperative strokes. In patients who presented with H/H grade 5, the odds ratio for developing perioperative stroke was 9.21 (95% CI: 1.28–66.13) respectively. In the absence of Aneurysm rupture, patients presenting with new-onset stroke were more likely to suffer postoperative complications, stay in the intensive care unit longer, and be discharged to in-patient rehabilitation compared to patients without new-onset stroke. This study suggests that severity of subarachnoid hemorrhage based on the patient’s clinical condition increases the risk of perioperative stroke in patients with surgical Aneurysm Clipping. SSEP changes and high-grade H/H scores can serve as independent predictors of perioperative stroke, with the latter having the greatest predictive value.

Todd A Mackenzie – One of the best experts on this subject based on the ideXlab platform.

  • unruptured cerebral Aneurysm Clipping association of combined open and endovascular expertise with outcomes
    Journal of NeuroInterventional Surgery, 2016
    Co-Authors: Kimon Bekelis, Todd A Mackenzie, Daniel J Gottlieb, George Bovis, Stavropoula Tjoumakaris, Pascal Jabbour
    Abstract:

    Background It is often questioned if one physician can conduct both open and endovascular techniques successfully and safely. Objective To investigate the association of combined open and endovascular expertise with the outcomes of unruptured cerebral Aneurysm Clipping. Methods We performed a cohort study of 100% of Medicare fee-for-service claims data for elderly patients who underwent surgical Clipping for unruptured cerebral Aneurysms between 2007 and 2012. To control for confounding we used propensity score conditioning, and controlled for clustering at the physician level. Results During the study, 3247 patients underwent Clipping for unruptured cerebral Aneurysms, and met the inclusion criteria. Of these, 766 (23.6%) underwent treatment by hybrid neurosurgeons, and 2481 (76.4%) by proceduralists, who performed only Clipping. Multivariable regression analysis with propensity score adjustment demonstrated a lack of association of combined practice with 1-year postoperative mortality (OR=0.81; 95% CI 0.51 to 1.28), discharge to rehabilitation (OR=0.95; 95% CI 0.72 to 1.25), length of stay (adjusted difference 0.85 days; 95% CI −0.31 to 2.00), or 30-day readmission rate (OR=1.05; 95% CI 0.80 to 1.39). Higher procedural volume was independently associated with improved outcomes. Conclusions In a cohort of Medicare patients with unruptured Aneurysms, we did not demonstrate a difference in mortality, discharge to rehabilitation, or readmission rate between hybrid neurosurgeons and surgeons performing only Clipping.

  • a predictive model of hospitalization cost after cerebral Aneurysm Clipping
    Journal of NeuroInterventional Surgery, 2016
    Co-Authors: Kimon Bekelis, David W Roberts, Symeon Missios, Todd A Mackenzie, Nicos Labropoulos
    Abstract:

    Background Cost containment is the cornerstone of the Affordable Care Act. Although studies have compared the cost of cerebral Aneurysm Clipping (CAC) and coiling, they have not focused on identification of drivers of cost after CAC, or prediction of its magnitude. The objective of the present study was to develop and validate a predictive model of hospitalization cost after CAC. Methods We performed a retrospective study involving CAC patients who were registered in the Nationwide Inpatient Sample (NIS) database from 2005 to 2010. The two cohorts of ruptured and unruptured Aneurysms underwent 1:1 randomization to create derivation and validation subsamples. Regression techniques were used for the creation of a parsimonious predictive model. Results Of the 7798 patients undergoing CAC, 4505 (58%) presented with unruptured and 3293 (42%) with ruptured Aneurysms. Median hospitalization cost was US$24 398 (IQR $17 079 to $38 249) and $73 694 (IQR $46 270 to $115 128) for the two cohorts, respectively. Common drivers of cost identified in the multivariate analyses included the following: length of stay, number of admission diagnoses and procedures, hospital size and region, and patient income. The models were validated in independent cohorts and demonstrated final R 2 values very similar to the initial models. The predicted and observed values in the validation cohort demonstrated good correlation. Conclusions This national study identified significant drivers of hospitalization cost after CAC. The presented model can be utilized as an adjunct in the cost containment debate and the creation of data driven policies.

  • predicting inpatient complications from cerebral Aneurysm Clipping the nationwide inpatient sample 2005 2009
    Journal of Neurosurgery, 2014
    Co-Authors: Kimon Bekelis, David W Roberts, Symeon Missios, Todd A Mackenzie, Atman Desai, Adina S Fischer, Nicos Labropoulos
    Abstract:

    Object Precise delineation of individualized risks of morbidity and mortality is crucial in decision making in cerebrovascular neurosurgery. The authors attempted to create a predictive model of complications in patients undergoing cerebral Aneurysm Clipping (CAC). Methods The authors performed a retrospective cohort study of patients who had undergone CAC in the period from 2005 to 2009 and were registered in the Nationwide Inpatient Sample (NIS) database. A model for outcome prediction based on preoperative individual patient characteristics was developed. Results Of the 7651 patients in the NIS who underwent CAC, 3682 (48.1%) had presented with unruptured Aneurysms and 3969 (51.9%) with subarachnoid hemorrhage. The respective inpatient postoperative risks for death, unfavorable discharge, stroke, treated hydrocephalus, cardiac complications, deep veinvein throthrombosis, pulmonary embolism, and acute renal failure were 0.7%, 15.3%, 5.3%, 1.5%, 1.3%, 0.6%, 2.0%, and 0.1% for those with unruptured Aneurysms and …