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Papers by Richard Parkinson

Contemporary Neurosurgery, 2005

Learning Objectives: After reading this article, the participant should be able to: 1. Explain th... more Learning Objectives: After reading this article, the participant should be able to: 1. Explain the evolution of balloon occlusion testing. 2. Describe the advantages and disadvantages of the tests commonly associated with balloon occlusion. 3. Describe the protocol and procedure the authors use in performing balloon test occlusion.

Journal of neurosurgery, 2005

The authors report the case of a pediatric patient with bilateral fibromuscular hyperplasia (FMH)... more The authors report the case of a pediatric patient with bilateral fibromuscular hyperplasia (FMH) of the renal arteries who sustained a subarachnoid hemorrhage (SAH) caused by the rupture of a superior cerebellar artery aneurysm. The aneurysm was successfully treated with microsurgical clip occlusion. The association between renal artery FMH and aneurysmal SAH is extremely rare and incompletely understood. There are six previously published cases in the English literature; only one case involved direct aneurysm treatment and none involved the posterior circulation. In addition to presenting this case, the authors discuss the complexities involved in treating these patients from a technical and conceptual standpoint.

Contemporary Neurosurgery, 2004

The advent of endovascular therapy for intracranial aneurysms and the rapid advances in that fiel... more The advent of endovascular therapy for intracranial aneurysms and the rapid advances in that field have supplanted microsurgical treatment for many intracranial aneurysms. Applying current outcome data and other parameters, nuances of selecting the modality of treatment for intracranial aneurysms are reviewed. Patient factors, such a age, co-morbidities, vasospasm and other medical conditions, are addressed. A custom-tailored multimodality treatment paradigm for the management of ruptured and unruptured aneurysms will maximize the favorable results seen in this difficult patient population.

Surgical Neurology, 2007

Background: Carotid cavernous fistulae are abnormal communications between the carotid artery sys... more Background: Carotid cavernous fistulae are abnormal communications between the carotid artery system and the cavernous sinus. Endovascular treatment is the treatment of choice, but because of their heterogeneous etiology and anatomy, an appropriate treatment plan must be tailored for each patient. Case Description: A 77-year-old diabetic woman presented with rapid onset of right eye pain, conjunctivitis, and chemosis. Angiography revealed an indirect CCF located in the posterior wall of the right cavernous sinus. N-Butyl cyanoacrylate was injected directly into the fistula site in the dural wall via a microcatheter, resulting in a cure. Conclusion: We describe an unconventional treatment of an indirect CCF from an IPS approach. One type D 2 CCF was treated successfully using only N-butyl cyanoacrylate injected directly at the fistula site. This was achieved by microcatheterization of the fistula in the posterior wall of the right cavernous sinus.

Journal of Neurosurgery, 2006

✓ The treatment of large and giant paraclinoid carotid artery (CA) aneurysms often requires the u... more ✓ The treatment of large and giant paraclinoid carotid artery (CA) aneurysms often requires the use of suction decompression for safe and effective occlusion. Both open and endovascular suction decompression techniques have been described previously. In this article the authors describe a revised endovascular suction decompression technique that provides several advantages in the treatment of large and giant paraclinoid and CA aneurysms. A 51-year-old woman presented with a relatively brief history of progressive visual loss in the right eye, nonspecific headache, and an afferent pupillary defect. After angiography studies had been obtained, it was determined that she had a giant right paraclinoid internal CA aneurysm with a dome size of approximately 26 mm on the right and a neck diameter of 10 mm. A modified technique was performed in which suction decompression was used. With the aid of a No. 7 French Concentric balloon guide catheter (Concentric Medical, Inc., Mountain View, CA)...

Journal of Neurosurgery, 2007

✓The authors report a unique case of subarachnoid hemorrhage caused by a traumatic pseudoaneurysm... more ✓The authors report a unique case of subarachnoid hemorrhage caused by a traumatic pseudoaneurysm of the ophthalmic artery, which was successfully treated with coil embolization. Clinical and imaging features, as well as the relevant literature, are described.

Diagnostic Cytopathology, 1990

Journal of Sports Medicine, 2013

Background. Rugby league is a physically demanding team sport and the National Rugby League is th... more Background. Rugby league is a physically demanding team sport and the National Rugby League is the highest-level competition of rugby league in Australia. Frequent tackles and collisions between players result in a high incidence of injury to players. Concussion injuries have been the source of much debate, with reporting varying greatly depending on the definition used.Method. Injury records of 239 players from one professional National Rugby League were analysed during a continuous period of 15 years, with particular interest in the incidence and recurrence of concussions and the change in incidence over time.Result. A total of 191 concussions were recorded, affecting 90 players. The incidence of concussion injuries was found to be 28.33 per 1000 player match hours, with an increase over time (P=0.0217). Multiple concussions were recorded for 51 players.Conclusion. A statistically significant increase in the incidence of concussion injuries was found, without a concurrent increase...

Neurosurgery Clinics of North America, 2005

Neurosurgery, 2005

OBJECTIVE AND IMPORTANCE: To describe our experience with the transradial approach for posterior ... more OBJECTIVE AND IMPORTANCE: To describe our experience with the transradial approach for posterior circulation neurointerventional procedures. To the best of our knowledge, this approach has not been described previously for intracranial neuroendovascular procedures. CLINICAL PRESENTATION: The clinical and imaging characteristics as well as periprocedural outcomes of patients treated for intracranial posterior circulation disease via the transradial approach were analyzed retrospectively. INTERVENTION: Between January 1 and October 21, 2003, four patients with posterior circulation disease (aneurysm, n = 1, and atherosclerotic stenosis, n = 3) were treated via the transradial approach because of tortuous brachiocephalic anatomy. Procedural success was 100%, and there were no procedural complications. No technical difficulties were encountered. CONCLUSION: The transradial approach is an alternative to the femoral approach for posterior circulation neuroendovascular intervention. This a...

Minimally Invasive Surgery, 2012

Neurosurgery, 2006

OBJECTIVE: Currently, there is minimal published data on the use of heparin-coated stents in the ... more OBJECTIVE: Currently, there is minimal published data on the use of heparin-coated stents in the neurovasculature; however, these stents have a proven clinical record in the treatment of coronary disease. This article details our experience with the safety and technical aspects of stent deployment in the first 10 patients who had heparin-coated stents placed in the intracranial and cervical vasculature and the preliminary follow-up in most cases. METHODS: We retrospectively reviewed the clinical history, intra- and periprocedural data, and imaging for the patients who received heparin-coated stents in the cervical and intracranial vasculature for cerebrovascular disease between October 2002 and October 2003. RESULTS: Thirteen heparin-coated stents were placed in 10 patients. Seven out of the 10 patients had heparin-coated stents placed in the posterior circulation; the remaining three patients had stents placed in the anterior circulation. Four patients had stents placed intracrania...

Otolaryngologic Clinics of North America, 2010

Journal of Science and Medicine in Sport, 2010

Journal of Neuro-Ophthalmology, 2009

Endovascular transvenous treatments have become the mainstay in the management of indirect caroti... more Endovascular transvenous treatments have become the mainstay in the management of indirect carotid-cavernous fistulas (CCFs). However, the standard coil techniques are associated with a substantial failure and complication rate. The ethylene vinyl alcohol copolymer (Onyx) Liquid Embolization System has advantages over coils, including the ability to penetrate and occlude vessels of small caliber or with difficult access. This was a review of 5 consecutive patients with indirect type D CCFs who underwent 6 procedures using the Onyx system alone at the Prince of Wales Hospital, Sydney, between December 2005 and May 2007. The cavernous sinus was catheterized with MTI Echelon-10 or Rebar-14 microcatheters via the femoral vein using an inferior petrosal approach to the cavernous sinus in 5 procedures and directly via the superior ophthalmic vein in 1 procedure. All 5 patients had complete closure of the fistulas as seen on imaging and full reversal of ophthalmic manifestations without lingering complications and with substantially shorter procedure times than with conventional approaches. The Onyx system is a safe and useful method of closing indirect CCFs transvenously. This is the first series report of the use of the Onyx system alone in the treatment of these vascular abnormalities.

Journal of Clinical Neuroscience, 2010

Clinical Neurology and Neurosurgery, 2014