bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunosuppressant Strategies for Intestinal Transplantation: A Review of a Tolerogenic Regimen
Authors: Flynn Bridget , Park Beverly Kosmach , Bond Geoffrey , McGhee William , Mazariegos George , Sindhi Rakesh , Reyes Jorge , Abu-Elmagd Kareem
Published: January 2017

Intestinal, combined liver-intestinal, and multivisceral transplantation are now considered the standard of care for children and adults with permanent intestinal failure. Early attempts at intestinal transplantation were discouraging because of the high incidence of technical complications, rejection, and infection. Advances in the field of transplantation, including the introduction of tacrolimus, improved surgical techniques, and improvements in postoperative care, have led to a renewed interest in intestinal transplantation since 1990. The most significant achievement, however, has been the effective control of rejection and life-threatening infections. This article focuses on the experience to date of innovative strategies that induce lymphocyte depletion and reduction in the incidence of rejection. In this setting, low-maintenance immunosuppression is clinically achievable with an acceptable rate of allograft rejection. Subsequently, the long-term complications of immunosuppression are significantly reduced with achievement of better long-term survival, and an overall improvement in the quality of life.
West Nile Virus: A Challenge for Transplant Programs
Authors: Hoekstra Cindy
Published: January 2017

West Nile virus is a new challenge for transplant programs worldwide. It is a mosquito-borne disease, which has become increasingly prevalent in North America since it was first recognized in New York in 1999. A review of a case study and the literature shows that the morbidity and mortality associated with West Nile virus infection and transplant recipients are alarmingly high. Treatment options are limited because of transplant programs' limited experience in working with this virus. Transplant programs must develop action plans for education on West Nile virus and its prevention to decrease the risk of infection among their transplant recipients.
Factitious Wound Infections in an Altruistic Living Liver Donor
Authors: Levenson James L. , Valverde Rodolfo , Olbrisch Mary Ellen
Published: January 2017

We report a case of recurrent factitious wound infections in an altruistic living liver donor. Costs for the infections after donation were billed to the recipient, creating a threat to the recipient's lifetime benefits. This case illustrates the importance of obtaining previous medical records on living donors.
Patients' Willingness to Talk to others about Living Kidney Donation
Authors: Rodrigue James R. , Cornell Danielle L. , Kaplan Bruce , Howard Richard J.
Published: January 2017

Background

Living donor kidney transplantation has several advantages for patients with end-stage renal disease. However, many patients are reluctant to pursue this treatment option, preferring instead to wait for a deceased donor organ.

Objective

To examine predictors of patients' willingness to talk to others about living kidney donation.

Methods

One hundred thirty-two adult patients awaiting kidney transplantation who were enrolled in a randomized trial examining the effectiveness of education on rates of live donor kidney transplantation completed a baseline rating of their willingness to talk to others about living kidney donation. Also, patients completed measures of knowledge and concerns about living donation and a rating of perceived health.

Results

Slightly more than half the patients (56.1%) had low willingness to talk to others about living donation. The following variables were associated with higher willingness to talk to others: white race (odds ratio, 3.31; confidence interval, 1.7–7.4), college education (odds ratio, 3.43, confidence interval, 2.0–5.6), fewer concerns about living donor kidney transplantation (odds ratio, 0.31; confidence interval, 0.2–0.6), and less favorable perceptions of their current health status (odds ratio, 4.31; confidence interval, 2.6–7.6).

Conclusion

White race, more education, less concern about living donor kidney transplantation, and poorer perceived health are associated with greater willingness to talk to others about living kidney donation. These findings have important implications for educating patients about living donor kidney transplantation.
Skin Cancer Education in Transplant Recipients
Authors: Feuerstein Ilana , Geller Alan C.
Published: January 2017

In the past 20 years, long-term survival for solid-organ transplant recipients has improved dramatically; about 223 000 patients are alive in the United States with organ transplants today. As survival rates improve, however, the morbidity and mortality associated with lifelong immunosuppressive therapy is increasing in significance. Skin cancer is common among recipients of all major organ transplants, including the kidney, liver, heart, lung, and pancreas. Although skin cancer is the most common cancer in transplant recipients, many cases can be prevented by sun protection, skin self-examinations, and physician examinations. Because transplant recipients visit the transplant clinic frequently, clinicians have ample opportunities to teach patients about the importance of prevention and detection of skin cancer. At a routine visit, the clinician should inquire about sun protection practices, especially for tanned, light-skinned, or freckled patients or patients who are planning a warm-weather vacation or time in the sun during the summer. Skin cancer education should be integrated into the care of transplant patients as part of their numerous visits to the transplant clinic. Although some transplant recipients may resist adopting new behaviors at first, use of the ample clinic opportunities for patient education can dramatically reduce their risk of skin cancer.
Psychiatric Disorders: Are They an Absolute Contraindication to Living Donation?
Authors: Rowley Anthony A. , Hong Barry A. , Martin Susan , Jones Linda , Vijayan Anitha , Shenoy Surendra , Jendrisak Martin
Published: January 2017

Little information has been published about the suitability of candidates for living organ donation who have a past or current psychiatric diagnosis. A retrospective review of 445 living donor kidney transplants performed at Barnes-Jewish Hospital's transplant center from 1995 to 2005 disclosed 42 donor candidates with such a history, prompting detailed psychological evaluation. Although 41 candidates (10% of the donor pool) met criteria for 1 or more psychiatric diagnoses, none were considered psychologically unfit for donation. Of these, 22 candidates underwent kidney donation without medical or surgical complications and without development of subsequent active psychological problems. Several donors maintained long-term contact up to 12 years to report good health and a high degree of satisfaction with the decision to donate. This experience suggests that for donor candidates with a psychiatric diagnosis, formal psychiatric evaluation to evaluate current mental health stability is warranted. Stable individuals, on or off therapy, can be considered fit to donate with expected short- and long-term outcome prognoses similar to those for the general population.
Use of Clinical Practice Guidelines to Promote Best Practice When Managing Clinical Interventions for Liver Transplant Candidates
Authors: Jarrett Maree
Published: January 2017

Background

Limited organ availability and an increasing demand for organ transplantation has extended transplant waiting times and thus increased morbidity and mortality for potential recipients on waiting lists. The Queensland Liver Transplant Service identified use of clinical practice guidelines developed from evidence-based practice as a strategic clinical management/workflow tool that could improve clinical outcomes for patients awaiting liver transplant.

Method

An extensive review of publications related to the management of advanced liver disease in potential transplant recipients was undertaken and the supporting evidence was identified. In all stages of development of the guidelines, the multidisciplinary collaborative team of clinicians used recommended principles from The Appraisal of Guidelines, Research and Evaluation collaboration. The liver transplant recipient coordinator acted as facilitator for the project, identifying positive factors and resolving obstacles.

Results

Key focus areas in optimizing medical management before liver transplant were identified with the aim of preventing disease progression and complications that would jeopardize patients' outcome. Clinical practice guidelines were developed for each key area to optimize care by promoting appropriate timing of clinical interventions.

Conclusion

Practices that required change to comply with identified best practice were investigated, and clinical practice for the outpatient medical management of potential liver transplant recipients with chronic liver disease were developed collaboratively. These guidelines have been accepted and are being implemented within the gastroenterology and hepatology department at the Princess Alexandra Hospital.
Developing New Ways to Address Learning Needs of Adult Abdominal Organ Transplant Recipients
Authors: Myers Jaime , Pellino Teresa A.
Published: January 2017

Context

The degree to which patients are knowledgeable about posttransplant care can affect outcomes and patients' satisfaction. Transplant team members must identify knowledge gaps, contributory factors, and innovative methods to address learning needs.

Objective

To identify patients' perceptions of their knowledge gaps and identify ways to improve current approaches to patient education.

Design

Nonexperimental.

Setting

Midwestern teaching hospital.

Patients

726 adult abdominal organ transplant recipients.

Intervention(s)

A patient education survey was mailed out to solid-organ transplant recipients who met study criteria. A modified version of the Patient Learning Needs Scale (PLNS) was used to identify the recipients' learning needs. Additional questions on the survey addressed factors that we hypothesized would influence responses to the PLNS and asked patients which methods would help them learn during various phases of the transplant process.

Main Outcome Measure(s)

Statistical analysis was conducted on survey responses.

Results

Overall, PLNS scores were satisfactory in all 4 categories. Analysis of PLNS subscales revealed significantly lower scores in the quality of life/psychosocial subscale compared with the other 3 subscales. Significantly lower scores in the medications and follow-up categories of the PLNS items were found among the group whose length of stay was between 15 to 30 days compared with patients with shorter and longer stays. A variety of different methods are desired by patients in order to get information, especially before transplant.
Outcomes of Kidney Transplantation Abroad
Authors: Quach Kevin , Sultan Heebah , Li Yanhong , Famure Olusegun , Kim S. Joseph
Published: January 2017

Context:

An increasing demand for kidney transplantation has enticed some patients with end-stage renal disease (ESRD) to venture outside their country of residence, but their posttransplant outcomes may be suboptimal.

Objective:

We compared the risks and clinical outcomes among tourists, or patients who pursue a kidney transplant abroad, versus patients who received a transplant at the Toronto General Hospital (TGH).

Methods:

A single-center, 1:3 matched (based on age at transplant, time on dialysis, and year of transplant) cohort study was conducted. Forty-five tourists were matched with 135 domestic transplant recipients between January 1, 2000, and December 31, 2011. Multivariable Cox proportional hazards models were fitted to assess graft and patient outcomes.

Results:

Among the 45 tourists, the majority (38 of 45) traveled to the Middle East or Far East Asia, and most received living donor kidney transplants (35 of 45). Multivariable Cox proportional hazards models showed that tourists had a higher risk for the composite outcome of acute rejection, death-censored graft failure, or death with graft function (DWGF; hazard ratio [HR] 2.08, 95% confidence interval [CI]: 1.06-4.07). Tourists also showed a higher risk for the individual end points of acute rejection, DWGF, and posttransplant hospitalizations.

Conclusion:

Patients going abroad for kidney transplantation may have inferior outcomes compared to domestic patients receiving kidney transplants. Patients who are contemplating an overseas transplant need to be aware of the increased risk of adverse posttransplant outcomes and should be appropriately counseled by transplant professionals during the pretransplant evaluation process.
Psychological Issues Associated With Absolute Uterine Factor Infertility and Attitudes of Patients Toward Uterine Transplantation
Authors: Saso Srdjan , Clarke Alex , Bracewell-Milnes Timothy , Saso Anja , Al-Memar Maya , Thum Meen-Yau , Yazbek Joseph , Priore Giuseppe Del , Hardiman Paul , Ghaem-Maghami Sadaf , Smith J. Richard
Published: January 2017

Context:

Uterine transplantation (UTx).

Objective:

To explore patients’ knowledge of and attitudes toward UTx before and after a short educational intervention via a video and question and answer (Q&A) session.

Design:

Large, in-depth survey investigating patients’ motivations, aims, and beliefs on UTx.

Setting:

Imperial College London.

Participants:

Women diagnosed with absolute uterine factor infertility (AUFI) who were seeking information on UTx and had already volunteered to participate in the study.

Intervention:

A semistructured interview involving a brief baseline questionnaire before a Q&A session and a 20-minute video exploring the main risks and benefits for UTx.

Main outcome measures:

Attitudes of self-referred patients with AUFI toward UTx before and after education focusing on UTx. Rank order of importance of key UTx-related issues.

Results:

Forty women were interviewed. Following the video presentation and Q&A session, 97.5% (n = 39) would undergo UTx ahead of surrogacy and adoption in full knowledge that the latter 2 options would be ultimately safer for their own well-being and the fact that the graft could fail even prior to conception. All felt that UTx should take place, and 92.5% saw UTx as achievable.

Conclusion:

The study demonstrates a keen interest in UTx, partly because other options seem difficult to access. It is worth noting that people appear to be distancing themselves from the risk. This requires careful assessment in any clinical program. This study is the first to demonstrate a qualitative relationship between patients with AUFI and their curiosity and desire for UTx. It paves the way for forming the introduction into the psychological assessment of a potential patient.
Genetic Aspects of Cerebrovascular Malformations
Authors: Shovlin C.L.
Published: January 2017

In the last decade there have been fundamental advances in our understanding of the pathogenesis of vascular malformations. These advances have resulted from the application of molecular methods to identify disease genes, rather than from immunohistochemical or physiological studies. This presentation reviews the genetic basis of a variety of cerebral vascular malformations which occur as part of well-characterised diseases inherited in an autosomal dominant manner. These highlight the diversity of mechanisms which can perturb vascular development, and should have significant implications for the development of new therapies.
Evaluation of Local Intra-Arterial Fibrinolytic Therapy for Acute Middle Cerebral Artery Occlusion
Authors: Tamatani S. , Sasaki O. , Koizumi T. , Nishimaki K. , Ito Y. , Koike T. , Takeuchi S. , Tanaka R.
Published: January 2017

Fibrinolytic therapy for acute ischaemic stroke has been investigated in several clinical trials, with various protocols. This retrospective study was undertaken to evaluate the efficacy and limitation of local intra-arterial fibrinolytic therapy using urokinase (UK) in patients with acute middle cerebral artery occlusion.

Fifty patients were treated with local intra-arterial fibrinolytic therapy within six hours after onset of symptoms. The median National Institutes of Health Stroke Scale (NIHSS) score was 17 (range, 6 to 28). Two hundred and forty thousand IU of UK was administered through a mi-crocatheter for 20 minutes. When arterial recanalization was not achieved, a second or third infusion was performed. Maximum dosage of UK was 0.96 × 106 IU. Recanalization efficacy was evaluated at the end of fibrinolytic therapy and intracranial haemorrhage was assessed within 24 hours. Clinical outcome was evaluated three months after ictus with modified Rankin scale (RS).

Thirty-nine patients (78%) obtained recanalization. Twenty-nine of 39 (74%) showed clinical improvement just after treatment. On the other hand, only 18% patients (2/11) who did not recanalize demonstrated improvement. Twenty-five of 50 (50%) patients recovered to RS score 0 or 1, however, only 28% of patients (5/18) with proximal M1 occlusion obtained good outcome and 39% of them (7/18) died. The mean time interval from onset to treatment did not affect outcome. The overall incidence of haemorrhagic event (HE) within 24 hours was 36%, however, 78% of patients with proximal M1 occlusion showed HE. Only one patient with HE clinically deteriorated.

In conclusion, local intra-arterial fibrinolytic therapy could be a safe and effective method for acute middle cerebral artery occlusion, however, indication of this therapy for patients with proximal M1 occlusion should be carefully decided.
Moyamoya Syndrome: Post Cranial Irradiation of Pineal Gland Tumor
Authors: Chiewvit P. , Janyavanich V. , Soonthonpong N. , Churoj A. , Chawalparit O. , Suthipongchai S.
Published: January 2017

A right-handed eight-year-old boy, with headache, vomiting and positive parinaud's sign was diagnosed as having a pineal gland tumor which histopathological section from surgical biopsy revealed to be a germinoma. The patient underwent ventriculoperitoneal shunt for obstructive hydrocephalus. Thereafter, he received cranial irradiation as definitive treatment. He was well and went back to school until five years later he developed a transient ischemic attack. Cranial magnetic resonance imaging showed a complete cure of the pineal tumor without any other specific abnormality. Eight months later he had an episode of stroke which was demonstrated by cranial computed tomography as acute left cerebral infarction in the middle cerebral artery territory. Cerebral angiography showed Moyamoya syndrome.
Treatment of Trapped CCF by Direct Puncture of the Cavernous Sinus by Infraocular Trans-SOF Approach
Authors: Workman M.J. , Dion J.E. , Tong F.C. , Cloft H.J.
Published: January 2017

We present a case of recurrent carotid-cavernous fistula after prior ipsilateral carotid artery ligation. Due to lack of endovascular access, embolization was performed by direct puncture of the cavernous sinus via a transorbital approach. Operative technique and an anatomical basis for treatment are described.
Effects of Endothelial Injury on the Rate of Thrombus Organization in Canine Carotid Arteries Occluded with Microcoils
Authors: Abruzzo T. , Shengelaia G.G. , Workman M. , Cloft H.J. , Miller D.A. , Dion J.E.
Published: January 2017

Thrombus organization in canine carotid arteries occluded with platinum microcoils was studied to determine if endothelial injury created with a Xenon Chloride Excimer Laser (XEL) could acclerate endovascular fibrosis.

Ten common carotid artery stumps were created in ten dogs. Each of four stumps were schematically divided into four longitudinally contiguous injury zones (thermal ablation injury, non-ablative injury, proximal and distal non-injury zones) to test the effects of ablative and non-ablative injury and to establish a set of internal controls that would account for proximity to circulating blood at the ostium of the occluded artery. Following XEL irradiation of the endothelium through an arteriotomy, each stump was embolized with microcoils. Four control stumps were subjected to sham laser procedures, and embolized in an identical fashion. Two additional stumps were embolized in the absence of sham surgery. Angiographic, gross and histologic analysis was performed after four weeks. Specimens of freshly clotted whole blood mixed with microcoils were used as an additional control.

In irradiated stumps and non-irradiated stumps (sham and embolization only), angiography revealed no evidence of coil compaction or recanalization. In all irradiated stumps the thermal ablation zone contained fibrous tissue and neovascularity without unorganized thrombus. The other zones in the irradiated stumps were indistingnishable from each other and from all zones in the non-irradiated sham stumps, containing primarily unorganized thrombus. Stumps embolized in the absence of sham surgery were filled with material that was grossly and microscopically identical to specimens of freshly clotted whole blood containing microcoils.

The results indicate that thermal ablation injury of the endothelium accelerates thrombus organization in canine carotid arteries occluded with platinum microcoils.
Factors Leading to and Treatment of Aneurysmal Perforation during Coil Embolization
Authors: Terada T. , Tsuura M. , Matsumoto H. , Masuo O. , Shintani A. , Ryujin Y. , Itakura T.
Published: January 2017

It is important to know the characteristics of aneurysms that tend to cause perforation and treatment of these perforations to reduce the morbi/mortality of the endovascular treatment for intracranial aneurysms. Factors leading to aneurysmal perforation were analyzed from the view points of aneurysmal status (ruptured or unruptured), size and direction of aneurysmal dome from the parent artery and treatment of perforation during GDC embolization was discussed in 105 consecutive cases. Perforation occurred in three small aneurysms (less than 3 mm in diameter or depth) where the direction of the dome is the same as that of microcatheter advancement. Perforation occurred when a microcatheter was advanced to counteract catheter recoil caused by coil deployment. Haemorrhage occurred in all cases immediately following microcatheter and coil perforation into the subarachnoid space. In all cases, bleeding was controlled by deploying the coil so that it extended from the subarachnoid space back into the intraaneurysmal cavity. In two cases, surgical clipping was required to treat the incompletely obliterated aneurysm. No additional permanent neurological deficit occurred as a result of any of the three perforations. Special care should be taken during the embolization of small aneurysms (less than 3 mm in minimal diameter) where, owing to the shape of the lesion, or fixation of a microcatheter by the stent strut, the antegrade force of the canulating microcatheter is transmitted directly toward the aneurysm dome.
Spinal Arteriovenous Malformation Associated with a Radicular Arteriovenous Fistula Suggested a Metameric Disease
Authors: Nishio A. , Ohata K. , Takami T. , Gotoh T. , Tsuyuguchi N. , Ichinose T. , Terakawa Y. , Hara M.
Published: January 2017

A spinal intramedullary arteriovenous malformation (AVM) associated with a radicular arteriovenous fistula (AVF) is reported. The patient had mild myelopathy and low back pain. Spinal angiography revealed the AVM fed by the anterior spinal artery via left T10, T11 and right L1 radiculomedullary arteries and the radiculopial arteries of left L1, L2 and right T11, L3 levels and the radicular AVF at the left L4 level. There were three radiculomedullary arteries within four levels in our case. This spinal AVM associated with a radicular AVF is considered a genetic nonhereditary lesion with metameric link.
Venous Sinus Stent-Assisted Angioplasty for Refractory Benign Intracranial Hypertension
Authors: Zhongrong M. , Feng L. , Shengmao L. , Fengshui Z.
Published: January 2017

Two patients with dural sinus stenosis of different causes presenting with refractory benign intracranial hypertension were confirmed by angiogram. Stent-assistant angioplasty was used to dilate the stenosed sinusesand led to prompt clinical improvement. Relative long-term follow-up showed good patency of the stented sinuses.
The Underlying Mechanisms of Endovascular Exclusion of Intracranial Aneurysms by Coils
Authors: Henkes H. , Brew S. , Miloslavski E. , Fischer S. , Tavrovski I. , Hne D. K.
Published: January 2017

Endovascular coil treatment of intracranial aneurysms is now widely accepted. We discuss some of the arguments for the relative roles of electrothrombosis, spontaneous thrombosis, mechanical filling, haemodynamic effects and surface properties in successful coil treatment. Despite an enormous body of literature, with many theories and much data, there is limited evidence for, or understanding of, the mechanisms by which coil treatment protects against aneurysm rupture. It seems likely that electrothrombosis plays no part. Dense packing is probably important in preventing recurrence. New technologies aiming to encourage endothelialisation and increased connective tissue formation appear promising.
Multifocal Cerebral Venous Malformations and Associated Developmental Venous Anomalies in a Case of Blue Rubber Bleb Nevus Syndrome
Authors: Chung J.I. , Alvarez H. , Lasjaunias P.
Published: January 2017

We report a sporadic case of probable BRBN (blue rubber bleb nevus syndrome) with multiple CNS (central nervous system) involvement. These features consisted of multiple VMs (venous malformations) and DVAs (developmental venous anomalies) in supratentorial brain, cerebellum, and diencephalon. Since its first description by Bean, there have been many cases of BRBN manifesting with gastrointestinal bleeding with or without associated hemorrhage. Cases with CNS involvement were rarely reported and many of the descriptions were confusing with different terminologies used to describe them such as capillary venous malformation, hemangiomas, and vascular malformations. The lesions illustrated are venous malformations similar to our case. The association of DVA was recognized in some cases; they are likely to be underestimated when revisiting the published case illustrations. Although our case is sporadic, the link with HHT1 is unlikely despite the involvement of the same chromosome (Ch 9).
In-Vitro Simulation of NBCA Embolization for Arteriovenous Malformation
Authors: Inagawa S. , Isoda H. , Kougo H. , Isogai S. S. , Sakahara H.
Published: January 2017

Embolization using n-butyl-cyanoacrylate (NBCA) for arteriovenous malformation (AVM) is now a daily practice over the world, but there exists no objective data that can be a basis for discussion or decision-making on the best concentration and injection rate of NBCA mixture. The purpose of this study was to obtain objective data on control and behavior of NBCA mixture with an in vitro simulation system of NBCA embolization for AVM.

A nidus model made of a one-ml syringe filled with small beads was connected to a pulsatile flow circuit. A microcatheter was introduced just before the nidus model. Endoluminal pressures proximal and distal to the nidus and flow volume through the nidus were measured. Digital subtraction angiography (DSA) was performed to calculate transit time of the contrast medium (CM) through the nidus. NBCA was injected at various rates with an autoinjector and transit time of NBCA through the nidus was calculated.

27 trials were completed. Transit time of CM through the nidus model is well correlated to flow volume per unit of time through the nidus model. Shorter the transit time, larger was the flow volume per unit of time. The correlation was statistically significant (P < .0001). Though statistical significance was not attained, transit time of NBCA mixture at 50% concentration had a tendency to be correlated to flow volume per unit of time through the nidus, and slower injection of the NBCA mixture led to slower filling of the nidus model.

Though this simulation system was artificial and the results should be interpreted carefully, it was shown with this system that transit time of CM through the nidus could be a good index for flow volume per unit of time through the nidus. Also suggested was a possibility to utilize this in vitro system for research and training on NBCA embolization of AVM.
Paravertebral Arteriovenous Malformation Supplied by Branches of the Iliac Arteries
Authors: Corr P. , Royston D.
Published: January 2017

Arteriovenous malformations of the spine and spinal cord can be classified into spinal cord arteriovenous malformations (AVMs) and fistulas (AVFs) and dural AVM and AVF occurring outside the dura but draining into the epidural veins called paravertebral AVM and AVF 1. Paravertebral malformations are rare arteriovenous communications outside the dura but draining into the epidural veins. These malformations produce symptoms from either venous congestion of the cord or cord compression from dilated epidural veins resulting in a myelopathy. We present a case of a patient with a lumbar paravertebral malformation treated successfully by endovascular occlusion of the feeders.
Dural Sinus Malformations (DSM) with Giant Lakes, in Neonates and Infants
Authors: Barbosa M. , Mahadevan J. , Weon Y.C. , Yoshida Y. , Ozanne A. , Rodesch G. , Alvarez H. , Lasjaunias P.
Published: January 2017

Background and Purpose

Dural Arteriovenous Shunt (DAVS) in children include Dural sinus malformation (DSM), infantile and adult types. They are rare and seldom reported. Our purpose was to highlight the angiographic features of the DSM sub group for prognosis of clinical evolution and outcome and to lay guidelines for management.

Methods:

From a dedicated neurovascular data bank, there were 52 cases of arteriovenous dural shunts in children from 1985 to 2003. Of these, there were 30 patients with DSM, which we analysed the various angioarchitecture, presentation and neurological outcome. Children clinical status was evaluated and scored at admission and follow up.

Results

There was an overall male dominance of 2:1. Antenatal diagnosis was obtained in 8/30 (26.7%) cases. Mean age of diagnosis was 5 months. Mean age at first consultation was 8.7 months. No patient was diagnosed during childhood. The most common clinical presentations were macrocrania 76.7%, seizures 23.3% and mental retardation 23.3%. In 14/30 (35.7%) of the patients, the therapeutic decision was to manage conservatively; in 5/14 (30.7%) with predictable favourable evolution and in 9/14 (64.3%) with irreversible poor neurological outcome. In the remaining 16/30 (53.3%) patients, endovascular treatment was performed. In 12/16 (75.0%) patients the neurological outcome was good, 3/16 (18.8%) patients had unfavourable evolution despite embolization. There was no morbidity mortality related to the procedures themselves. 1/16 (6.3%) patient was lost to follow-up. Overall 12/29 (45.8%) patients had an unfavourable neurological outcome with 11 patients dead and 1 with severe neurological deficit. In the surviving group of children, 17/18 (94.4%) have a good neurological outcome; in 10/18 (55.5%) the lesion is morphologically excluded.

Conclusion

DSM is rare disease with high mortality. They usually proceed to either total or partial spontaneous thrombosis before the age of 2 thus compromising normal cerebral venous drainage. DSM away from the torcular, good cavernous sinus, cavernous capture of sylvian veins, absence of pial veins, straight sinus or superior sagital sinus (SSS) reflux and absence of jugular bulb dys-maturation represent factors of good prognosis. Such patients will highly benefit for endovascular treatment. In partial endovascular approach the aim being is to separate the brain drainage from DSM drainage. This will be achieved by the transarterial approach to the associated mural arteriovenous shunts (AVS) and by disconnecting the pial reflux by transvenous route.
Acute Severe Epistaxis Due to Iatrogenic Maxillary Pseudoaneurysm
Authors: Duncan I.C. , Fourie P.A.
Published: January 2017

Internal maxillary arterial or branch transection is a potential complication of maxillofacial surgery. We describe one such patient who developed acute massive nasal haemorrhage, an episode of which was controlled clinically just prior to performing endovascular embolization by employing the simple but effective clinical manoeuvre of manual carotid arterial compression. Six weeks later the haemorrhage recurred despite a seemingly adequate embolization of the affected arteries with microcoils and Spongistan due to re-establishment of flow through the coils.
Hereditary Haemorrhagic Telangiectasia in Children. Endovascular Treatment of Neurovascular Malformations
Authors: Krings T. , Chng S.M. , Ozanne A. , Alvarez H. , Rodesch G. , Lasjaunias P. L.
Published: January 2017

Hereditary haemorrhagic telangiectasia (HHT) is a heterogeneous disease that may present with different clinical phenotypes and different clinical expressions. Concerning the neurovascular expressions of this disease, the paediatric age group in particular presents with potentially devastating symptomatic phenotypes. The purpose of this article was to review the therapeutic results of endovascular treatment of neurovascular malformations in children.

A total of 31 children under the age of 16 were included in this retrospective analysis. All children were treated in a single centre. Twenty children presented with 28 arterio venous (AV) fistulae including seven children with spinal AV fistulae and 14 children with cerebral AV fistulae (one child had both a spinal and cerebral fistulae). Eleven children had small nidus type AV malformations. All embolizations were performed in a single centre employing superselective glue injection. Follow-up ranged between three and 168 months (mean: 66 months)

A total of 115 feeding vessels were embolized in 81 single sessions resulting in a mean overall occlusion rate of the malformation of 77.4% (ranging from 30 to 100%). Two of 30 patients (6.5%) died as a direct complication of the embolization procedure, two patients (6.5%) had a persistent new neurological deficit, eight patients (26.7%) were clinically unchanged following the procedure. In 11 patients (36.7%) an amelioration of symptoms but no cure could be achieved, six patients (20%) were completely asymptomatic following the endovascular procedure. In the surviving patients morphological complete occlusion was possible in twelve patients (38%), therapy is still not complete in six patients.

Since the natural history of neurovascular manifestations of HHT in children is associated with a high morbidity and mortality, therapeutic intervention is mandatory. In most instances a morphological target can be identified, therefore even partial and staged treatment can be performed. Our results demonstrate that in 27/31 patients these targeted interventions resulted in stabilizing the disease, ameliorating the symptoms or even in curing the patient. The endovascular approach employing glue as the embolizing agent represents therefore a safe and efficient way to control the neurovascular phenotypes of HHT.
Symptomatic Radionecrosis after AVM Stereotactic Radiosurgery
Authors: Finitsis S. , Anxionnat R. , Bracard S. , Lebedinsky A. , Marchal C. , Picard L.
Published: January 2017

The purpose of our study was to analyze the outcome of symptomatic radionecrosis following stereotactic radiosurgery for brain arterio venous malformations. Of 225 patients treated by linear accelerator radiosurgery for brain AVM, 16 (7, 1%) presented post-radiosurgery symptomatic radionecrosis on a mean follow-up period of 50 months (range 1–123 months). Once diagnosed with radionecrosis, 14 of 16 patients were subjected to high dose corticotherapy consisting of escalating doses of dexamethasone for several weeks. The mean interval of occurrence of new symptoms was 11.6 months post-radiosurgery (range 6–20 months). The mean time of follow-up was 2.9 years post radiotherap y ranging from seven months to eight years. Of the 16 patients with symptomatic radionecrosis, 11 (68, 75%) showed complete resolution of symptoms while five (31, 25%) showed improvement but still presented a neurological deficit at the closing date of the study. At the closing date, 11 patients (68.75%) had angiographically completely obliterated arterio venous malformations while another two patients had an obliteration of 95% to 98% and one patient had a 98% obliteration with development of a new contralateral AVM. In our series, symptomatic radionecrosis occurred in 7.1% of patients treated with stereotactic radiosurgery for brain AVM.

These patients where subjected to a prompt, high dose corticosteroid treatment and most presented symptom resolution or improvement with a fair obliteration rate, offering protection from bleeding. Permanent neurologic deficits attributable to radionecrosis occurred in 2.2% of our patient population treated with stereotactic radiosurgery for brain AVM.
Combined Neuroform Intracranial Stent and Bioactive Matrix Detachable Coil for Embolization of a Broad-Necked Persistent Primitive Trigeminal Artery Aneurysm
Authors: Zhao Q.P. , Li T.L. , Duan C.Z. , Chen G.Z.
Published: January 2017

We report a patient with a wide-necked aneurysm arising at the bifurcation of the right internal carotid artery and the persistent primitive trigeminal artery (PPTA) treated successfully by Matrix detachable coil occlusion and assisted by a Neuroform intracranial stent. First, a Neuroform self-expanding intracranial stent was delivered via a 5-F Guider Softtip XP and placed as desired, then the aneurysm dome was embolized with two Matrix detachable coils through the interstices of the stent. The aneurysm was 80% occluded angiographically and the parent artery was patent. DSA imaging six months after the procedure showed the aneurysm to be obliterated at angiography and the neck tissue thickness of the aneurysm to be increased, but the parent artery diameter was not impacted. We describe the case in detail and discuss our preliminary experience of using the Neuroform stent and Matrix detachable coils for the treatment of a PPTA wide-necked aneurysm.
Endovascular Treatment of Ruptured Anterior Communicating Artery Aneurysms
Authors: Nakai Y. , Sonobe M. , Kato N. , Okamoto S. , Nakamura K. , Sugita K.
Published: January 2017

The aim of this paper is to provide a review of our experience in using the endovascular treatment of ruptured anterior communicating artery (ACoA) aneurysms. Between March 1997 and May 2004, 211 ruptured aneurysms were treated with Guglielmi detachable coil (GDC) system in Mito Medical Center, 73 were located at the ACoA. Two cases were incomplete embolization, and performed microsurgical clipping. In the initial embolization for the 71 aneurysms, complete occlusion was achieved in 44 aneurysms, neck remnant in 11 aneurysms and body filling in 16 aneurysms. Intra-operative complication was occurred in six cases (8.2%).

Aneurysm perforation was occurred in three cases (4.1%), thromboembolic complication was occurred in three cases (4.1%). Acute rebleeding were observed in two cases (2.7%). Endovascular treatment is an effective technique for treating ACoA aneurysms, and 3D-rotational angiography is important diagnostic tool for evaluating the ACoA complex.
Applications and Roles of Coil Embolization and/or Clipping in the Treatment of Cerebral Aneurysm
Authors: Sato E. , Konishi Y. , Shimada A. , Komatsubara K. , Yazaki H. , Fujitsuka M. , Shiokawa Y.
Published: January 2017

We retrospectively analysed to demonstrate the selection of the treatment modality and its efficacy in our department. Subjects of the present study comprised patients in whom coil embolization was abandoned due to such reasons as broad neck, whom coil embolization was performed for residual aneurysm following incomplete clipping or recurrent cerebral aneurysm, whom coil embolization was performed after coil compaction, whom coil embolization and clipping were performed for the treatment of multiple cerebral aneurysms.

In the treatment of cerebral aneurysm, selecting proper techniques by considering the characteristics of clipping and coil embolization is desirable.

In other words, strategizing therapy by taking advantages of the merits of clipping and coil embolization is important.
Evaluation of the Stability of Small Ruptured Aneurysms with a Small Neck after Embolization with Guglielmi Detachable Coils
Authors: Kai Y. , Hamada J. , Morioka M. , Yano S. , Kuratsu J.
Published: January 2017

It is difficult to predict the compaction of Guglielmi detachable coils (GDC) after endovascular surgery for aneurysms. Therefore, we studied the relationship between the coil packing ratio and compaction in 62 patients with acute ruptured intracranial aneurysms that were small (<10 mm) had a small neck (<4 mm) and were coil-embolized with GDC-10.

We recorded the maximum prospective coil length, L, as the length that correspond with the volume of packed coils occupying 30% of the aneurysmal volume. L was calculated as L (cm) = 0.3 × a × b × c and the coil packing ratio expressed as packed coil length/L × 100, where a, b, and c are the aneurysmal height, length, and width in mm, respectively. Angiographic follow-up studies were performed at three months and one and two years after endovascular surgery.

Of the 62 patients, 16 (25.8%) manifested angiographic coil compaction (ten minor and six major compactions); the mean coil packing ratio was 51.9 ± 13.4%. The mean coil packing ratio in the other 46 patients was 80.5 ± 20.2% and the difference was statistically significant (p<0.01). In all six patients with major compaction the mean packing ratio was below 50%.

We detected 93.8% of the compactions within 24 months of coil placement. In patients with small, necked aneurysms, the optimal coil packing ratio could be identified with the formula 0.3 × a × b × c. The probability of compaction was significantly higher when the coil packing ratio was under 50%. To detect coil compaction post-embolization, follow-up angiograms must be examined regularly for at least 24 months.
Coil Embolization for Ruptured Cerebral Aneurysms of 2×3 mm Diameter
Authors: Tone O. , Tomita H. , Tamaki M. , Akimoto H. , Shigeta K. , Sampetrean O. , Fujii M.
Published: January 2017

Small ruptured cerebral aneurysms, such as those of 2×3 mm diameter, are considered to be difficult to embolize by detachable coils because of the risk of procedural perforation of the aneurysms. We have treated these small aneurysms and report the techniques and pitfalls of these embolizations. Twenty-four patients with ruptured cerebral aneurysms of 2×3 mm diameter were intended for treatment by coil embolization. Before coil embolization, three-dimensional digital subtraction angiography was performed, and the simulation of the volume embolization ratio (VER) was performed in all patients, except for the first basilar artery aneurysm patient. The tip of the microcatheter was steam-shaped several times and was placed on the neck of the aneurysm. A balloon neck remodeling technique was used for two aneurysms. GDC 10 softs and soft SRs were used for the first ten aneurysms, and Ultrasofts were used for the last eleven aneurysms. Out of twenty-four aneurysm embolizations, we aborted the procedure in three cases, because of a failure in catheterization; we performed clipping surgery for these cases. For the first case of a basilar tip aneurysm, the aneurysm was perforated, due to the use of too long a coil and the insertion of the tip of the microcatheter into the aneurysmal dome. Minor infarction occurred in one patient.

The mean VER was 33.9%, and two aneurysms recanalized, and out of these one needed a second embolization. Six months postoperatively, 81% of patients had made in a good recovery or had a moderate disability. We recommend the following techniques to embolize aneurysms of 2×3 mm diameter: the tip of the microcatheter should be stabilized on the aneurysmal neck by steam shaping of the microcatheter, GDC 10 soft and Ultrasoft should be selected for use, and the simulation of the VER should be performed before embolization to select coils of a suitable length.
Morphological Change of Unruptured Vertebral Artery Dissection on Serial MR Examinations
Authors: Nagahata M. , Manabe H. , Hasegawa S. , Takemura A.
Published: January 2017

Basi-parallel anatomical scanning (BPAS)-MRI is a simple MRI technique to reveal the surface contour of the intracranial vertebrobasilar artery.

The purpose of this study was to investigate the usefulness of BPAS-MRI for observing the temporal course of unruptured vertebral artery (VA) dissection in patients by means of serial MR examinations. Since April 2003, we performed serial MR examinations in four patients with unruptured acute vertebral artery dissection. The frequency of the MR examinations during the follow-up period in each patient varied from twice within seven months to five times within 19 months. Both MRA and BPAS-MRI were obtained in each MR examination.

We investigated the course of morphological changes within the dissected artery on BPAS-MRI (outer contour) and on MRA (inner lumen).

Although the initial MRA showed fusiform dilatation, irregular stenosis or normal caliber at the dissected lesion, the initial BPAS-MRI disclosed fusiform dilatation in all of the four patients. In two patients, MRA finding of the VA lesion had changed, though the fusiform appearance had been stationary on BPAS-MRI. Then both dissolution of the fusiform dilatation on BPAS-MRI and normalization of the inner luminal caliber on MRA were confirmed within nine months.

In one patient, fusiform dilatation on both BPAS-MRI and MRA resolved simultaneously on the MR examination at eight months after the initial symptom. In another patient, fusiform dilatation of the outer contour was still enlarging on BPAS-MRI ten months after the onset, though the fusiform dilatation on MRA had been stationary since the eighth week. We performed endovascular coil embolization in this patient eleven months after the initial symptom.

Resolution of the fusiform dilatation on BPAS-MRI should be a healing sign of VA dissection. Persisting the fusiform dilatation or progressively enlarging outer contour on BPAS-MRI may be an unstable sign. BPAS-MRI provides more information about the instability of the dissected lesion. We should obtain not only MRA but also BPAS-MRI for the course observation of unruptured VA dissection.
Pediatric Thoraco-Lumbar Paraspinal Arteriovenous Fistulas along the Segmental Nerve
Authors: Niimi Y. , Berenstein A. , Fernandez P.M. , Brisman J.L. , Song J.K.
Published: January 2017

To characterize the clinical presentation, imaging features and endovascular treatment of paraspinal non-vertebral arteriovenous fistulas along the segmental nerve.

Retrospective review was performed on the five patients identified in our database covering 1985 to 2003. All patients presented with an incidentally found continuous murmur over the upper paraspinal or parasternal regions before three years old. In four patients, the AV fistula was in the mid-thoracic level and at L3 in one. All AV fistulas were a high-flow single-hole fistula at the neural foramen with venous drainage into paraspinal and epidural veins without intradural reflux. All fistulas were endovascularly occluded in the same session as the diagnostic angiography. The fistula was occluded with detachable coils in one case and with N-butylcyanoacrylate (NBCA) with flow control in four cases. Complete occlusion of the fistula was obtained in all cases and all patients remained neurologically intact at the last follow up (average six years). Non-vertebral paraspinal arteriovenous fistula along the segmental nerve is a specific disease entity seen in children. Embolization is the first choice of treatment for this disease.