Endovascular Procedures

A systematic search of English-language literature using MEDLINE, CINAHL, EMBASE, Cochrane, LLBA (Linguistics and Language Behaviour Abstract), Web of Science, Scopus and PsychINFO (January 1980 to May 2015) was performed along with a manual search of the cited references of the selected articles and the search cited features of PubMed. Appendix 1 lists the search strategy performed on MEDLINE as an example of the literature search performed in each database. The search was limited to comparative analyses between individuals who had a TBI and non-injured individuals (control). This study was not registered with PROSPERO.
The review includes studies assessing prosodic processing outcomes after the following procedures: traumatic brain injury, subdural hematomas, cerebral aneurysms, craniotomy (for glioma and meningioma), craniotomy for subdural hematoma, burr hole(s) for subdural hematoma, cerebral aneurysm repair by craniotomy and endovascular technique, ventriculoperitoneal shunt insertion and revision, endoscopic third ventriculostomy, surgical treatment of epilepsy, temporal lobectomy, amygdalohippocampectomy, hemispherectomy, callosotomy and other procedure for seizures, or other neurosurgical cranial procedures for brain tumors, and epilepsy.
Articles that discussed the following outcomes: communication disorders, prosodic impairments, aphasia, and recognition of various aspects of prosody, were included and were examined for assessments and reports of prosodic processing impairments. Methods of summary included study characteristics, sample characteristics, demographics, auditory processing task, age at injury, brain localization of the injury, time elapsed since TBI, reports between TBI and mental health, socialization and employment difficulties in studies assessing TBI and auditory processing evaluations. There were no limitations to the population size, age or gender.
We collected the electronic records in an Endnote data file. Titles and abstracts of the electronic search results were screened by one of the authors (WL) to identify the relevant studies. One of the authors (WL) and an undergraduate student (SW) independently evaluated the quality of the articles in the search and extracted data using data abstraction forms. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria for quality assessment were applied to evaluate each article on study quality and external and internal validity [31 (link)]. Agreement between the two raters was very high (Cohen’s kappa = .89, P < 0.001). Results are reported according to the PRISMA guidelines [32 (link)].
Information was extracted primarily from the “Results”, “Discussion” and “Methods” sections with some input from the “Background” section. Information that was extracted included study characteristics, participant characteristics, localization and mechanisms of brain injury, severity of TBI, time-elapsed since injury, methods and results pertaining to prosodic processing post-TBI, author’s interpretation of results and conclusions. Internal validity was evaluated by examining the study design (blinding, statistical tests, reliability, participant recruitment, validity and biases) and external validity was based on whether or not the sample was representative of the entire population. Please note that the localization of brain injuries was reported based on the damage to the brain, not of the skull and surrounding protective tissues. However, localization was reported if damage to the surrounding tissue damaged the brain.

Stroke surgery was performed as previously described in detail (30 (link)). Due to the presence of a rete mirabile in sheep, endovascular methods are precluded and direct access to the cerebrovasculature is required [for details and review please see (10 (link), 44 (link)–46 (link))]. To achieve this, an incision was made between the right ear and orbital rim, coronoid process of the mandible lateralised, and skull base exposed to perform a small craniotomy using a pneumatic drill (Midas Rex^® Legend Electric System, Medtronic USA). A 2 cm skull flap was removed, underlying dura breached, proximal middle cerebral artery (MCA) located, and an aneurysm clip (Aesculap YASARGIL^® Aneurysm Clip, Germany) placed over the vessel which remained in situ for 2 h. The clip was subsequently removed to achieve reperfusion, dura closed watertight with synthetic matrix (Durepair^®, Medtronic, USA) and cyanoacrylate adhesive (Bostik, Australia), cranioplasty performed using dental cement (Sledgehammer, Keystone, Germany), and surgical site closed in layers using polyglactin suture (Vicryl^®, ETHICON). Arterial blood samples were obtained at hourly intervals intra-operatively to maintain the animal within normal physiological limits.

Patients were divided into 2 groups according to the treatment strategy: (1) CAS group (patients treated with stenting of the cervical lesion during MT) and (2) nonstenting group (patients treated with balloon angioplasty or thrombectomy with thromboaspiration and/or stent retriever, only aspiration of the extracranial ICA lesion, or deferred or no extracranial ICA intervention). Information on patients’ demographic characteristics, risk factors and comorbid conditions, National Institutes of Health Stroke Scale (NIHSS) scores, modified Rankin Scale (mRS) scores, smoking status, history of antithrombotic treatment, and intravenous thrombolysis administration were abstracted from the medical record review. Imaging characteristics included baseline Alberta Stroke Program Early CT Score (ASPECTS), etiology of the extracranial ICA lesion, occlusion site (as determined on computed tomography angiography or digital subtraction angiography), and degree of stenosis and lesion type (as determined on digital subtraction angiography). Stroke workflow time metrics were time from last known well (LKW) to groin puncture, door to arterial puncture, and arterial puncture to reperfusion. Procedural variables included intracranial stenting and/or angioplasty, cervical revascularization technique in reference to the ICA lesion (anterograde vs retrograde), and antiplatelet therapy regimens (when stenting was performed) categorized as single, dual, and/or intravenous antiplatelet(s) administered immediately before, during, or after the endovascular therapy procedure. Treatment with intravenous thrombolysis was determined at the discretion of the treating clinician. All intracranial occlusions were treated using stent retriever and/or contact aspiration catheters. The endovascular and medical therapeutic interventions were performed according to each institution’s protocol with the patient under conscious sedation or general anesthesia and at the discretion of the interventionalists.