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NEUROSURGERY
CEREBROVASCULAR SURGERY PROGRAM

PROGRAM OVERVIEW:
The Cerebrovascular Program is a multidisciplinary program involving neurosurgeons, neuroradiologists, stroke neurologists, nurses and trainees in each of these disciplines.  Halifax is the referral centre for the treatment of cerebrovascular disorders in Atlantic Canada with extensive experience in surgical and endovascular management of aneurysms and arteriovenous malformations (AVM), and the only centre with a stereotactic radiosurgery program for the treatment of patients with AVMs.  The cerebrovascular team meets weekly to review clinical cases from all of the Atlantic Provinces, and discuss recommendations for a multidisciplinary evidence-based approach to patient care.

MISSION: 
Our team is dedicated to providing world class, innovative care for patients with cerebrovascular disorders.

PROGRAM GOALS:

To treat patients with cerebrovascular disorders using the latest technology
To advance the knowledge and techniques for the treatment of cerebrovascular disorders through education and research
To translate research to evidence based practice

RESEARCH:
We have had an active year in research, participating in several multi-center studies as listed below.  We maintain a cerebrovascular database that provides valuable information for local research endeavours.

ONGOING STUDIES:

CURES - The Canadian Unruptured Endovascular Coiling versus Surgical Clipping Trial, a randomized comparison of angiographic and clinical outcomes following treatment for unruptured intracranial aneurysms.  Currently enrolling.

MARCO POLO - Multicenter Randomized Trial on Selective Endovascular Aneurysm Occlusion with Coils versus Parent Vessel Reconstruction Using the Silk Flow Diverter. Currently enrolling.

STAT – Stenting in the Treatment of large, wide-necked or recurring intracranial Aneurysm Trial. Currently in the REB approval process, we anticipate enrollment to start in the spring of 2013.

Hi-DEF – High Dose Deferoxamine in Intracerebral Hemorrhage. We have been accepted as a North American site and are in the REB approval process.

ACCOMPLISHMENTS:
The Brain Aneurysm Support Group has been meeting regularly since October 2006.  This invaluable resource serves as an opportunity for brain aneurysm patients and families to share information, give and receive emotional support, educate each other, identify needs and access further resources. 
The 7th Atlantic Canada Stroke Conference was held in Halifax in September. 
Dr. Fleetwood was co-chair of the organizing committee.

We continue to treat patients from across the Maritime Provinces for a variety of complex cerebrovascular conditions.

FUTURE DIRECTIONS:
Program members continue to work together for the betterment of cerebrovascular care in Nova Scotia and the Atlantic Provinces.  Our research activity will continue in 2013 with the CURES and MARCO POLO trials ongoing and STAT and Hi-DEF beginning enrollment. Clinical research projects at the local level will be pursued, with opportunity provided to a summer student.

Publications:

Dmytriw AA, Pickett GE, Shankar JJS. Rupture of Posterior Communicating Aneurysms in the Immediate Post-Coiling Period. J Neurointervent Surg (December 2012.)

Belkhair S, Pickett GE. One vs double burrholes for treatment of chronic subdural hematoma: meta-analysis. Can J Neurol Sci (in press, Jan 2013.)

Shankar JJS, Pickett GE, Receveur D. Technique for plain CT and CT angiogram of the head in an obese patient. Can J Neurol Sci 39(4):546-7, 2012.

Shankar JJS, Vandorpe R, Pickett GE, Fleetwood I, Maloney W. SILK Flow-Diverter for Treatment of Intracranial Aneurysms: Initial experience and cost analysis. J Neurointervent Surg (in press.)

Shankar JJS, Menenzes R, Pohlmann-eden B, Wallace C, terBrugge K, Krings T. Angio-architecture of Brain AVM determines the presentation with seizures- proposed scoring system. AJNR (in press.).

Shankar JJS, terBrugge K, Krings T. Subarachnoid hemorrhage following posterior spinal artery aneurysm: endovascular treatment with parent vessel occlusion. Can J Neurol Sci 2012 Jul; 39(4):531-2.

Shankar JJS, Zhang J, Santos M, Lesiuk H, Mohan R, Lum C. Factors affecting long term restenosis after carotid stenting for carotid atherosclerotic disease. Neuroradiology. 2012 Dec; 54(12):1347-53.

Shankar JJS, Tan IYL, Krings T, terBrugge K, Agid R. CT Angiography for Evaluation of Cerebral Vasospasm following subarachnoid hemorrhage. Neuroradiology 2012 Mar; 54(3):197-203.

Shankar JJS, terBrugge K, Krings T. Spinal epidural arteriovenous fistula with double perimedullary reflux- Case report and possible pathomechanism. Can J Neurol Sc. 2012 Mar; 39(2):239-41.

Lum C, Babu S, Silva L, Shankar JJS, Santos, M. Outcome in small aneurysms (<4mm) treated by endovascular coiling. J Neurointerv Surg 2012 May 1; 4(3):196-8.

Presentations:

Belkhair S, Pickett GE. Single vs. double burrholes for treating chronic subdural hematoma: a meta-analysis. Presented at the 47th annual congress of the Canadian Neurological Sciences Federation, Ottawa ON, June 6-8, 2012.

AlRashidi S, Pickett GE, Schmidt M. Delayed posterior reversible encephalopathy syndrome after hypertensive therapy of vasospasm: case report. Presented at the 47th annual congress of the Canadian Neurological Sciences Federation, Ottawa ON, June 6-8, 2012.

Shankar JJS Flow diverter in intracranial aneurysms- in Indian Society of Neuroradiology (ISNR) annual meeting in Shillong, India, September 20th-23rd, 2012.

Shankar JJS Interventional Neuroradiology Techniques in the Management of Acute Ischemic Stroke- in Indian Society of Neuroradiology (ISNR) annual meeting in Shillong, India, September 20th-23rd, 2012.

Shankar JJS Interventional Neuroradiology Techniques in the Management of Acute Ischemic Stroke- in Atlantic Canada Stroke Conference, September 14th-15th, 2012.

Shankar JJS Flow diverter in intracranial aneurysms- as a guest speaker in Neurosciences rounds in QE II hospital, Halifax on September 12th 2012.

Shankar JJS Flow diverter in intracranial aneurysms- as a guest speaker in Radiology grand rounds in QE II hospital, Halifax on September 13th 2012.

Shankar JJS “Silk Flow Diverter- An Update”- At National Institute of Mental Health and Neuro-Sciences, Bangalore, India on February 17th, 2012.

Shankar JJS Recent advances in endovascular treatment of ischemic and Hemorrhagic Stroke- At Indian Medical Association meeting, Ramgarh Cantt, India on February 5th, 2012.

Shankar JJS Complications in Flow diverters for aneurysms- case presentation- Canadian flow diverter meeting, Calgary on January 26th, 2012.