Enlighten-Research publications by members of the University of Glasgow http://eprints.gla.ac.uk Minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label phase 3 trial with blinded endpoint

Background and Purpose-To describe baseline clinical features and outcomes of adults with moyamoya phenomenon treated at a single North American institution. Methods-We identified 34 adults with moyamoya phenomenon by review of angiographic records. Clinical presentation and baseline stroke risk factors were obtained by chart review. Follow-up was obtained prospectively. A 5-year Kaplan-Meier stroke risk was calculated. Results-The median age was 42 (range 20 to 79) years. Twenty-five were women. The initial symptom was ischemia, hemorrhage, or asymptomatic in 24, 7, and 3 patients, respectively. Twenty-two had bilateral involvement and 12 had unilateral moyamoya vessels. Baseline stroke risk factors were similar between groups. The median follow-up in 31 living patients was 5.1 (range 0.2 to 19.6) years. Fourteen patients were treated with surgical revascularization (20 total hemispheres). In medically treated symptomatic hemispheres, the 5-year risk of recurrent ipsilateral stroke was 65% after the initial symptom and 27% after angiographic diagnosis. Patients with bilateral involvement presenting with ischemic symptoms were at the highest risk of subsequent stroke (nϭ17, 5-year risk of stroke with medical treatment after first symptom of 82%). In surgically treated hemispheres, the 5-year risk of perioperative or subsequent ipsilateral stroke or death was 17%. This was significantly different compared with medical treatment after first symptom (Pϭ0.02) but not after angiographic diagnosis. Conclusion-Moyamoya phenomenon in North American adults is associated with a high risk of recurrent stroke, particularly those with bilateral involvement and ischemic symptoms. These data suggest a potential benefit with surgery if diagnosis could be made earlier.

Objective-To describe initial experience with resting state correlation mapping as a potential aid for presurgical planning of brain tumor resections.Methods/Technique-Resting state blood oxygenation dependent (BOLD) fMRI was acquired in seventeen healthy young adults and four patients with brain tumors invading sensorimotor cortex. Conventional fMRI motor mapping (finger tapping protocol) was also performed in the patients. Intraoperatively, motor hand area was mapped using cortical stimulation.Results-Robust and consistent delineation of sensorimotor cortex was obtained using the resting state BOLD data. Resting state functional mapping in patients showed localization to sensorimotor areas consistent with cortical stimulation mapping (CSM) and in all cases performed as well or better than task-based fMRI.Conclusions-Resting state correlation mapping is a promising tool for reliable functional localization of eloquent cortex. This method compares well with "gold standard" CSM and offers several advantages in comparison to conventional motor mapping fMRI.