bluuebunny/crossref_metadata_2025 huggingface dataset:
Depression in Primary Caregivers of Patients Listed for Liver or Kidney Transplantation
Authors: Bolkhir Ahmed , Loiselle Marci M. , Evon Donna M. , Hayashi Paul H.
Published: January 2017

Background

No studies have examined depression in primary caregivers of adult patients listed for liver or kidney transplantation.

Objective

To determine the prevalence of depression among primary caregivers of patients listed for liver or kidney transplantation and to compare these 2 groups.

Design

A cross-sectional survey was conducted. The Center for Epidemiologic Studies Depression Scale and a demographic questionnaire were sent out and returned by mail.

Results

Of 72 eligible primary caregivers, 42 (58%) participated; the participation rate was similar for caregivers of kidney and liver failure patients (21/32 [66%)] vs 21/40 [53%], P = .3). Mean caregiver age was 54.7 ± 13.6 years. Twenty-three caregivers (54.8%) were spouses, 15 (35.7%) were first-degree relatives, and 26 (62%) were women. Median depression scale score was 5.5 (0–36). Three (7%), 2 (5%), and 3 (7%) participants reported mild, moderate, and severe depression, respectively. Median Center for Epidemiologic Studies Depression Scale score was higher among caregivers of liver versus kidney patients, but the difference was not statistically significant (9 vs 4, P = .2). Depression scale scores did not correlate with age, sex, time listed, or nature or length of relationship with the patient. The prevalence of depression in primary caregivers was 19%; of these caregivers, one third may have had severe depression.

Conclusions

The prevalence of moderate to severe depression in primary caregivers of liver and kidney transplant candidates is significant. The impact of depression on caregivers as well as patients, both before and after transplantation, deserves study. Screening for depression in caregivers could lead to clinical interventions that benefit caregivers and indirectly improve patient outcomes.
Racial Differences in the Living Kidney Donation Experience and Implications for Education
Authors: Lunsford Shayna L. , Shilling Lilless M. , Chavin Kenneth D. , Martin Margaret S. , Miles Lucia G. , Norman Michele L. , Baliga Prabhakar K.
Published: January 2017

Context

Much has been written about the barriers to deceased organ donation in the African American community. However, relatively little research has been conducted on barriers to living donation among African Americans. A shortage of suitable deceased donor kidneys among African Americans has encouraged donation from living donors.

Objective

As a follow-up to several focus groups with health professionals about barriers to living donation and suggestions for educational interventions, we sought to determine kidney donors' thoughts and feelings about their donation.

Design

Telephone interviews with past donors.

Participants

Nine African Americans and 9 whites were selected from a database of laparoscopic donor nephrectomies from 1993 to 2003.

Outcome Measures

Transcribed phone interviews were reviewed by 3 researchers to determine recurring themes and categorize responses.

Results

Responses were categorized into 8 areas of concern: health, financial, life with 1 kidney, procreation, psychosocial matters, surgery related, success of the transplant, and concerns about the future. Whites (n =9) tended to volunteer more for laparoscopic kidney donation than did African Americans (n = 2). African American concerns focused on future health and living with only 1 kidney, whereas whites had concerns about the surgery and the medical system.

Conclusions

Findings indicated that education is the best way to reach living donors and dispell fears. Promoting general health of African Americans may increase their willingness to be a living donor. Altruistic motives are the main motivation for donation, and intervention programs should target groups on a personal level to help individuals see that they can make a difference in improving or saving lives.
Targeting Stem Cells in Brain Tumors
Authors: Lasky Joseph L. , Liau Linda M.
Published: January 2017

Stem cells are commonly defined as undifferentiated cells capable of self-renewing and giving rise to a large number of differentiated progeny. It is becoming increasingly apparent that there exist cancer stem cells (CSCs) from which the cells of any given malignancy arise, whereby only a few cells out of a population of cancer cells are able to initiate tumor formation. These CSCs, like their normal counterparts, are characterized by self-renewal and the ability to “differentiate” into all of the cell types in the original tumor. Current chemotherapeutic strategies involve using non-specific cytotoxic agents that target rapidly cycling cells. Although this may reduce disease burden in many cases, these therapies may miss the rare, self-renewing population that truly gives rise to the malignancy (the CSC).

This review will focus on the recent discovery of stem cell-like cells in human brain tumors, putative “brain cancer stem cells,” which exhibit the properties of self-renewal and the ability to recapitulate the original tumor heterogeneity. Dissecting the molecular mechanisms that underlie the ability of these cells to self-renew and maintain quiescence may allow the development of novel therapeutic strategies that will allow for more efficacious and less toxic therapies for these devastating malignancies.
Respiration-Induced Intraorgan Deformation of the Liver: Implications for Treatment Planning in Patients Treated With Fiducial Tracking
Authors: Paulsson Anna K. , Yom Sue S. , Anwar Mekhail , Pinnaduwage Dilini , Sudhyadhom Atchar , Gottschalk Alexander R. , Chang Albert J. , Descovich Martina
Published: January 2017

Stereotactic body radiation therapy is a well-tolerated modality for the treatment of primary and metastatic liver lesions, and fiducials are often used as surrogates for tumor tracking during treatment. We evaluated respiratory-induced liver deformation by measuring the rigidity of the fiducial configuration during the breathing cycle. Seventeen patients, with 18 distinct treatment courses, were treated with stereotactic body radiosurgery using multiple fiducials. Liver deformation was empirically quantified by measuring the intrafiducial distances at different phases of respiration. Data points were collected at the 0%, 50%, and 100% inspiration points, and the distance between each pair of fiducials was measured at the 3 phases. The rigid body error was calculated as the maximum difference in the intrafiducial distances. Liver disease was calculated with Child-Pugh score using laboratory values within 3 months of initiation of treatment. A peripheral fiducial was defined as within 1.5 cm of the liver edge, and all other fiducials were classified as central. For 5 patients with only peripheral fiducials, the fiducial configuration had more deformation (average maximum rigid body error 7.11 mm, range: 1.89-11.35 mm) when compared to patients with both central and peripheral and central fiducials only (average maximum rigid body error 3.36 mm, range: 0.5-9.09 mm, P = .037). The largest rigid body errors (11.3 and 10.6 mm) were in 2 patients with Child-Pugh class A liver disease and multiple peripheral fiducials. The liver experiences internal deformation, and the fiducial configuration should not be assumed to act as a static structure. We observed greater deformation at the periphery than at the center of the liver. In our small data set, we were not able to identify cirrhosis, which is associated with greater rigidity of the liver, as predictive for deformation. Treatment planning based only on fiducial localization must take potential intraorgan deformation into account.
Discriminative Validity of the Motor-Free Visual Perceptual Test Revised in Children with and without Learning Disabilities
Authors: Burtner Patricia A. , Ortega Shannon Geisler , Morris Cecilia Gonzales , Scott Keri , Quails Clifford
Published: January 2017

Children who encounter difficulties in the major childhood occupation of academic learning are often identified as having learning disabilities. The Motor-Free Test of Visual Perception Revised (MVPT-R) is a standardized assessment frequently used by occupational therapists to measure a child's visual perceptual skills that contribute to successful learning. Although the MVPT-R has been revised with additional normative data and test items, no validity studies using different populations have been reported. The present study investigated the ability of the MVPT-R to differentiate between children with learning disabilities and matched control children. Two groups of 38 children (7–10 years of age) were compared on their MVPT-R scores. Results of t-test analyses showed children with learning disabilities: 1) scored significantly lower on MVPT-R raw (p = 0.01), perceptual quotient (p = 0.005), and perceptual age (p = 0.02) scores, and 2) had a significantly greater percentage of children scoring below criterion cutoff than control children.
The Occupation of Leisure: Three Typologies and Their Influence on Mental Health in Adolescence
Authors: Passmore Anne
Published: January 2017

In the occupational therapy literature reviewed, limited empirical research has tested the links between the occupation of leisure and health. This study examines the influences of leisure participation on mental health outcomes in adolescents and investigates the mediating constructs of self-efficacy, competence, and global self-worth as hypothesized in an a priori model developed from earlier research. With the use of a population-based approach, this study surveyed 850 adolescents aged 12 to 18 years, using a standardized self-report battery. Structural equation modeling was employed to investigate relationships and test the goodness-of-fit of the hypothesized model. Results demonstrate that leisure participation has a significant and positive relationship with mental health, and positively influences self-efficacy, competence, and global self-worth. However, results also show that only selected forms of leisure are positive influences on adolescent mental health development. These findings provide evidence to support a theoretical basis for the relationship between the occupation of leisure and health, and are discussed in relation to occupational therapy ideology.
A finite memory structure filtering for indoor positioning in wireless sensor networks with measurement delay
Authors: Kim Pyung Soo , Lee Eung Hyuk , Jang Mun Seok , Kang Shin-Yoon
Published: January 2017

In this article, an alternative indoor positioning mechanism is proposed considering finite memory structure filter as well as measurement delay. First, a finite memory structure filter with a measurement delay is designed for the indoor positioning mechanism under a weighted least-squares criterion, which utilizes only finite measurements on the most recent window. The proposed finite memory structure filtering–based mechanism gives the filtered estimates for position, velocity, and acceleration of moving target in real time, while removing undesired noisy effects and preserving desired moving positions. Second, the proposed mechanism is shown to have good inherent properties such as unbiasedness, efficiency, time-invariance, deadbeat, and robustness due to the finite memory structure. Third, through discussions about the choice of window length, it is shown that this can be considered as a useful design parameter to make the performance of the proposed mechanism as good as possible. Finally, computer simulations show that the performance of the proposed finite memory structure filtering–based mechanism can outperform the existing infinite memory structure filtering–based mechanism for the abruptly varying acceleration of moving target.
Monitoring of train-induced vibrations on rock slopes
Authors: Xu Jiangbo , Yan Changgen , Zhao Xu , Du Ke , Li Heng , Xie Yongli
Published: January 2017

Train-induced vibrations will undoubtedly influence the stability of slopes near railway lines. To monitor the effects of such vibrations on slope stability, a wirelessly networked vibration test system was established, which included wirelessly networked vibration meters, high-precision and high-speed three-dimensional sensors and a remote wirelessly networked data server system. This system represents the first attempt to monitor the effects of train-induced vibrations on the stability of slopes in China. It enables real-time and long-distance monitoring by means of remote transmission with a low cost and high efficiency. The duration, frequency, amplitude, peak acceleration and peak particle velocity were adopted as measures for evaluating the influence of train vibrations. Simultaneously, we used additional monitoring technologies to verify the conclusions of the wirelessly networked vibration test system. The monitoring results indicated that the peak particle velocity was much higher near the track and gradually decreased with increasing distance. When the distance between the measurement point and the road axis was 12 m ( H = 0 m), the maximal peak particle velocity was 0.4 mm/s, which remained below the maximum safe value.
Counter and Complicit Masculine Discourse Among Men’s Shed Members
Authors: Mackenzie Corey S. , Roger Kerstin , Robertson Steve , Oliffe John L. , Nurmi Mary Anne , Urquhart James
Published: January 2017

Men’s Sheds is a growing international movement aimed at providing men with places and activities that facilitate social connectedness. Despite Men’s Sheds’ focus on males, little attention has been paid to masculinities within the specific context of these settings. The current study used a gender relations framework to explore the ways in which attendees discussed Men’s Sheds, with particular attention to discussions that were complicit and counter to traditional, hegemonic views of masculinity, and diverse positions in between these binaries. The data consisted of transcripts and field notes from four focus groups comprising mostly older, White, retired male members of a Canadian shed ( N = 22). The analysis revealed three overall themes: (1) focus on work, (2) independence, and (3) need for male-focused spaces. These themes and associated subthemes suggest that shed members ascribe to dominant masculine values and ideals, but also support more fluid and flexible views of masculinity. Implications are discussed for how working with an array of masculinities within the Men’s Sheds movement will be helpful with respect to their future growth in Canada and internationally.
Concomitant Conus Medullaris Arteriovenous Malformation and Sacral Dural Arteriovenous Fistula of the Filum Terminale
Authors: Hsu SW , Rodesch G , Luo CB , Chen YL , Alvarez H , Lasjaunias PL
Published: January 2017

A patient with a spinal intradural arteriovenous malformation (AVM) at the conus medullaris concomitant with a sacral dural arteriovenous fistula (AVF) of the filum terminale is reported. A 44-year-old-male presentied with bilateral leg weakness and urinary incontinence for several months. Spinal angiography demonstrated two lesions: one was spinal intradural AVM at the conus medullaris supplied by the anterior spinal artery; the other was sacral dural AVF of the filum terminale supplied by the middle sacral artery.

Although multifocal spinal cord AVMs have been reported, this is the first case report of two different types of vascular malformations coexisting in one patient. The arterial supply of the dural AVF of the filum by the middle sacral artery is also first demonstrated in the literature. The patient was treated successfully by surgical approach for both lesions in the same operation.
A Recurred Carotid Siphon Pseudoaneurysm after Detachable Coil Embolization
Authors: Lee D. H. , Hur S. H. , Choi S.-J. , Jung S. M. , Ryu D. S. , Park M. S. , Lee S.Y.
Published: January 2017

Massive posterior epistaxis is one of the peculiar symptoms of pseudoaneurysms of the carotid siphon. We experienced a case of trauma-related pseudoaneurysm of the carotid siphon. The lesion was initially silent except for the mass effect. We initially treated the lesion with platinum detachable coil embolization of the pseudoaneurysm sac with preservation of the parent artery. However, the patient had delayed massive epistaxis with recurrence of the pseudoaneurysm. The patient was subsequently managed with endovascular occlusion of the affected internal carotid artery using detachable balloons. Complete internal carotid artery trapping is recommended as an initial treatment modality if the patient can tolerate to the occlusion test. Careful observation and follow-up of the patient is required if the lesion is inevitably managed with coil embolization of the pseudoaneurysm sac alone.
Facial Vein Approach by Direct Puncture at the Base of the Mandible for Dural Carotid-Cavernous Fistula
Authors: Naito I. , Magarisawa S. , Wada H.
Published: January 2017

A new facial vein approach by direct puncture at the base of the mandible is described for the treatment of dural carotid-cavernous fistulas. The facial vein is easy to identify, expose, and cannulate compared with the superior ophthalmic vein. The facial vein approach provides an alternative to the superior ophthalmic vein approach when the inferior petrosal sinus approach has failed.
Dural Sinus Thrombosis Complicated with Heparin Induced Thrombocytopenia and Thrombosis (HITT)
Authors: Lee S.-K. , Willinsky R. , terBrugge K.
Published: January 2017

A case of dural sinus thrombosis complicated with heparin induced thrombocytopenia and thrombosis (HITT) is presented. Interventional neuroradiologic procedures have potential risks of this devastating complication that is related with heparin. Clinical features and pathophysiologic mechanisms of HITT are discussed.
Persistent Autoregulatory Disturbance after Angioplasty for Cerebral Vasospasm
Authors: Song D.K. , Harrigan M.R. , Deveikis J.P. , McGillicuddy J.E.
Published: January 2017

Hyperdynamic therapy, consisting of hypervolemia, haemodilution, and hypertension, is an established treatment for cerebral vasospasm following subarachnoid haemorrhage. Angioplasty has emerged as an additional, effective treatment for symptomatic vasospasm. Loss of autoregulation, however, can occur despite effective angioplasty, underscoring the need for treatment with hyperdynamic therapy in combination with angioplasty.

A 43-year-old woman underwent endovascular coiling of a ruptured left posterior communicating artery aneurysm. The patient went on to develop symptomatic vasospasm and was treated with hyperdynamic therapy and angioplasty.

Autoregulation was assessed with xenon CT cerebral blood flow (CBF) measurement. An initial CBF study was obtained when the patient received dopamine and dobutamine infusions to maintain systolic blood pressure at 160 mmHg. The vasopressor drips were then temporarily held for twenty minutes, allowing the patient's systolic blood pressure to drop to 140 mmHg, and a repeat CBF study was obtained. Several days after angioplasty, CBF decreased significantly when the patient was taken off vasopressors, indicating impaired autoregulation. Hyperdynamic therapy was continued, and another CBF study one week later showed a return of autoregulation and normalization of CBF without induced hypertension.

Autoregulation is disturbed during vasospasm. Although angioplasty can improve large artery blood flow during vasospasm, hyperdynamic therapy is also needed to maintain cerebral perfusion, particularly in the face of impaired autoregulation. Quantitative CBF measurement permits the maintenance of optimal CBF and monitoring of response to therapy.
Clinical Results and Pathological Findings of Stent-Assisted Coil Embolization for Basilar Artery Trunk Dissecting Aneurysms
Authors: Nagashima H. , Hongo K. , Matsumoto Y. , Oya F. , Kobayashi S. , Higuchi K.
Published: January 2017

Stent-assisted coil embolization is a new method for treating dissecting or fusiform aneurysm, especially the aneurysms arising from the basilar artery trunk or dominant vertebral artery. At present, this technique is considered as an effective treatment option to obliterate such aneurysm keeping the parent artery patent. Several authors reported the effectiveness and excellent radiological result of this treatment, but fewer reports focus on the limitations of this technique.

We treated two patients with a basilar artery trunk dissecting aneurysm with this technique. Transient ischemic symptoms were observed in one patient and haemorrhagic and thromboembolic complications were observed the other. We lost the latter patient due to postoperative complications, and the pathological finding was achieved by autopsy. We report the clinical and pathological findings in the two cases and investigate the efficacy and limitations of this technique.
Intra-arterial Chemotherapy for Malignant Tumors of Head and Neck Region Using Three Types of Modified Injection Method
Authors: Kumagai T. , Takeda N. , Fukase S. , Koshu H. , Inoue A. , Ibuchi Y. , Yoneoka Y.
Published: January 2017

Relatively higher infusion rate in the intra-arterial chemotherapy (IA chemotherapy) could induce the higher concentration and the more sufficient distribution of chemotherapeutic agents on tumors. To get the relatively higher infusion rate in IA chemotherapy, we used three types of injection method: high-flow injection, high-dose injection with detoxification and flow-controlled injection method for the treatment of malignant brain tumors, skull base tumors and head and neck tumors.

Between January 1997 and October 2001, twenty-seven patients (mean age 61 y.o.) with supratentorial glioblastoma (4 cases), supratentorial anaplastic astrocytoma (1), CNS lymphoma (2), matastatic skull base tumors (3), and neck tumors (15 squamous cell carcinoma, 1 malignant melanoma and 1 neuroblastoma) received our three types of IA chemotherapy. Sixty-five consecutive procedures were performed. Conventional radiation therapy and/or surgical removal were performed in some of these patients. The median follow-up period was 10 months ranging 2 to 56 months.

Fifteen (55.6%) and 6 (22.2%) of 27 patients achieved complete response (CR) and partial response (PR) respectively after initial treatment [CR+PR: 21 (77.8%)]. All responded patients showed clinical improvement. The response rate declined to 55.6% at the end of follow-up period. Eighteen patients are still alive and 15 of them show no evidence of local recurrence. The median post treatment survival was 12 months. There was no serious complication except transient nausea in 4 of 27 (14%) patients, vertigo and granulocytopenia in 1 each (3%) of 27 patients.

Our modified IA chemotherapy has provided favorable clinical and radiological results without technical difficulties and serious complications.
Complications Associated with Stenting for Cerebral Arteries
Authors: Terada T. , Tsuura M. , Matsumoto H. , Masuo O. , Yamaga H. , Tsumoto T. , Itakura T.
Published: January 2017

We have experienced total 116 stenting for 102 of cranio-cephalic arteries and 14 of intracranial arteries including occlusive cerebrovascular diseases, aneurysms, and fistulas. Ten complications were encountered. Three were ischemic complication, four stent migration, two restenosis, and one aneurysmal perforation during coiling across the stent strut. The mechanism and preventive method of these complications were discussed in this paper.
The Study on the Patency of the Perforating Arteries after Stent Placement in Atherosclerosis Induced Rabbits
Authors: Masuo O. , Terada T. , Tsumoto T. , Yamaga H. , Nakai K. , Itakura T.
Published: January 2017

The number of successful case reports with percutaneous transluminal angioplasty (PTA) / stenting for intracranial atherosclerotic stenoses is recently increasing with the advent of flexible coronary stents. However, it is not well known whether the perforating artery is occluded or not after stent placement in the atherosclerotic stenotic vessels. We investigated this issue using five New Zealand white rabbits. We deployed stainless steel stents in the atherosclerosis-induced abdominal aorta across the lumbar artery in which the diameters of the abdominal arteries were similar to those of human intracranial arteries. We evaluated the patency of lumbar artery by angiography and scanning electron microscopy three months after stent placement. The lumbar arteries were patent in four out of five rabbits. However, SEM findings demonstrated stent struts were covered with thick neointima and the ostia between stent struts were partially occluded. It is possible that stent placement in the atherosclerotic arteries can cause the obliteration of the perforating arteries.
Fine Structure of Detached Coils Observed by Micro-CT
Authors: Fukasaku K. , Negoro M. , Fukui K. , Himeno R. , Yokota H.
Published: January 2017

Detached GDC was observed by high resolutional industrial microCT, whose resolution was higher than 0.1 mm. Unexpected destruction of the coils (kinking) was detected and unraveling also clearly visualized. Much higher resolution can improve safe and effectivity of GDC procedure.
Training in Neurovascular Intervention Usefulness of in-Vitro Model and Clinical Practice
Authors: Sugiu K. , Tokunaga K. , Sasahara W. , Watanabe K. , Nishida A. , Katsumata A. , Kusaka N. , Date I. , Ohmoto T. , Rufenacht D.A.
Published: January 2017

We introduce our training tools and system of neurovascular intervention. An in vitro cerebral vascular model was used for the young residents to understand the basic interventional techniques and devices.

The model included several vascular lesions such as cerebral aneurysm, dural arterio-venous fistula, or carotid artery stenosis. Endovascular procedures in the model were performed under fluoroscopic or direct visual control, and consecutive haemodynamic changes were visualized by using digital subtraction angiography and direct observation. Thus, traineess could have an easy understanding of clinical conditions. New medical devices, such as platinum coils, were successfully implanted in the model under stable conditions.

After the initial training using vascular model, the residents had started clinical experiences under the control of senior surgeons. Although it is difficult to describe usefulness of our clinical training, we believe that we provide enough good quality and quantity of clinical cases to the residents. Because our endovascular team has recently had 150–200 interventional procedures every year, one resident can have experienced more than 100 cases per year. The qualification of a Board Certified Specialist of the Japanese Society of Intravascular Neurosurgery (JSIN) requires that the applicant must have experienced more than 100 cases for four years. So our residents can have enough case materials to qualify the board examination.
The Choice of Treatment Method for Unruptured Cerebral Aneurysm
Authors: Manabe H. , Takemura A. , Hasegawa S. , Nagahata M. , Islam S.
Published: January 2017

To compare complications, anigographical results, duration of postoperative hospital stay and cost for treatment of surgical clipping and coil embolization in the treatment of unruptured cerebral aneurysm.

One hundred and nine non-giant saccular aneurysms in 90 patients were treated by either endovascular treatment (E group) or direct surgery (S group) in our Neurosurgical Department between April 1996 and April 2002. The complications and angiographical results were reviewed. The duration of postoperative hospital stay and cost for the treatment were calculated from bills for health insurance for 38 operations and 12 embolizations in 47 patients whose aim of hospitalization was only treatment for their unruptured aneurysm.

Neck clipping was performed for 89 aneurysms (S group), wrapping for four (S group), embolization using Guglielmi's detachable coils (GDCs) for 15 (E group), and failed embolization followed by clipping for one (E group). The postoperative temporary deficit (disappeared within one month) and permanent deficit was seen in five cases (6.7%) and in three cases (morbidity: 4.0%) of S group, and in one case (6.7%) and none (morbidity; 0%) of E group, respectively. No death was seen in both group (mortality; 0% in both group). The rate of angiographical complete occlusion of the aneurysm was significantly higher in S group (P = 0.015, 88% in S group vs 50% in E group). The postoperative hospital stay was significantly shorter in E group (P= 0.000013, mean days: 17.1 in S group vs 6.3 in E group), but cost for treatment was rather cheep in S group (N.S., mean cost: 1684329 yen in S group vs. 2259011 in E group).

This retrospective study suggested that surgical treatment may be less expensive treatment with higher rate of postoperative angiographical complete occlusion than coil embolization, and treatment-related complication rate was similar in both treatment.
Morphologic and Haemodynamic Changes after Stent Placement for Experimental Carotid Aneurysm
Authors: Tenjin H.
Published: January 2017

We investigated and compared the morphologic and haemodynamic changes between before and after stent placement when several different kinds of stents were applied to experimental aneurysms. Experimental aneurysms in eight pig carotid arteries were used. Stents were placed covering the aneurysm orifice. Five Cordis stents (coil stent), two GFXs (multilink stent), and one Multilink (tube stent) were used in this study. After stent placement, the arteries were perfused with 70% ethanol, the specimens were embedded in polyester plastic resin and thin slices were stained with hemtoxilin-eosin. Blood flow in the aneurysm was measured using digital subtraction angiography.

The parent artery was stretched in multilink stent (GFX) cases, and was most markedly stretched by use of the tube stent (Multilink). Stent placement with any type of stent decreased intra-aneurysmal blood flow.
Percutaneous Transluminal Angioplasty for Atherosclerotic Stenoses of Intracranial Vessels
Authors: Matsumaru Y. , Tsuruta W. , Takigawa T. , Hyodo A. , Sato H. , Matsumura A.
Published: January 2017

To study the efficacy and long-term outcome of percutaneous transluminal angioplasty (PTA) with/without stent placement for intracranial atherosclerotic stenoses, we reviewed our treated cases retrospectively. Between May 1992 and October 2003, PTA with/without stents was performed in 64 intracranial and skull base vessels in 62 patients, including 24 middle cerebral arteries, 16 internal carotid arteries, 13 vertebral arteries, and 11 basilar arteries. PTA was technically successful in 55 vessels (86%). However, four vessels (6%) failed to achieve satisfactory dilatation.

We encountered five periprocedural strokes as symptomatic complications, for a mortality rate of 4.7% and a morbidity rate of 3.1%. All the patients with stent placements survived angioplasty without any complication. In the clinical follow-up available for one week to 11.5 years (mean, 4.7 years), there were three strokes related to the treated vessels.

The annual stroke rate in the affected territory was estimated at 1.2% per year. According to these results, PTA for intracranial atherosclerotic stenoses seems to be a beneficial therapy for immediate anatomical results and long-term stroke prevention. Stent-assisted PTA could help patients achieve successful dilatation and avoid complications.
Early Treatment for Ruptured Cerebral Aneurysms
Authors: Kobayashi S. , Koguchi Y. , Fujikawa A. , Wada M. , Oish H. , Miysta A. , Nakamura H. , Yagishita T.
Published: January 2017

The purpose of this study was to evaluate the effect of endovascular treatment with Guglielmi detachable coils (GDC) on the outcomes of subarachnoid haemorrhage (SAH) patients of poor grades and high ages for each location of aneurysms.

Between 1990 and 2003, 529 SAH cases underwent angiograghy as candidates of early aggressive treatment in our hospital. For the 299 cases in 1990–96 (Group 1), treatment options were early and intensively delayed craniotomy surgery and conservative management, while for the 230 cases in 1997–2003 (Group 2), GDG embolization at acute stage was added to these three treatment options. We compared clinical courses and outcomes of the poor grade (Hunt & Kosnik Grade 4–5) patients and high age (> =70 years old) patients between two groups for each location of aneurysms.

Introduction of GDC embolization expanded the indication for early treatment in the poor grade patients with anterior communicating artery aneurysm (A-Comm An), the high age patients with internal carotid artery aneurysm (IC An) and all patients with Basilar bifurcation aneurysm (BA-Top An), and has contributed to improvement of their outcomes. To the poor grade patients with middle cerebral artery aneurysm (MCA An), GDC embolization was hardly indicated, because haematoma evacuation concomitantly performed with aneurysm occlusion would be necessary for those patients.

In conclusion, results of treatment with GDC embolization at an acute stage are desirable for poor grade patients with A-Comm An, aged patients with IC An and all patients with BA-Top An. The indication of GDC embolization for the patients with MCA An is limited.
Clinical Outcomes of Coil Embolization for Acutely Ruptured Aneurysm
Authors: Hirohata M. , Abe T. , Fujimura N. , Takeuchi Y. , Morimitsu H. , Shigemori M.
Published: January 2017

The purpose of this prospective study was to evaluate clinical results in patients with acutely ruptured cerebral aneurysm treated by neck clipping (NC) or coil embolization (CE) when CE was considered the first option. Between 1998 and 2003, 280 patients with acutely ruptured cerebral aneurysms excluding intracerebral hematoma were evaluated.

Patients were managed prospectively according to the following protocol: primary treatment modality was CE (n =179). NC (n=101) was selected for the patients with aneurysms that were small (less than 2 mm) or an unsuitable shape for CE. Surgical complication rates were 4.5% for CE and 16.8% for NC. Symptomatic vasospasm occurred in 8.4% of CE patients and 29% of NC patients. Good recovery on the Glasgow Outcome Scale was achieved by 71% of CE patients and 50% of NC patients at discharge. Surgical complications and symptomatic vasospasm were significantly reduced in CE compared to NC.

Clinical outcome at discharge was also better with CE. Although 18.3% of CE patients showed various degrees of aneurysmal recanalization and 7% of CE patients required additional treatment (re-CE or NC), aneurysmal rebleeding occurred in only one patient during follow-up (mean, 3.95 years).
Embolization of the Middle Meningeal Artery for Refractory Chronic Subdural Haematoma
Authors: Hirai S. , Ono J. , Odaki M. , Serizawa T. , Nagano O.
Published: January 2017

Endovascular embolization of the middle meningeal artery was performed in two cases of refractory chronic subdural haematoma (CSDH) after repeated burr hole and irrigation surgeries. The embolization prevented expansion of the CSDH in both cases, and the haematoma disappeared completely in one case. The expansion of CSDH is considered to result from repeated bleeding from the macrocapillaries on the haematoma capsule. Embolization of the middle meningeal artery appears to be useful to eliminate the blood supply to this structure.
PHACE Syndrome: Persistent Fetal Vascular Anomalies
Authors: Prochazka V. , Hrbac T. , Chmelova J. , Skoloudik D. , Prochazka M.
Published: January 2017

PHACE(S) syndrome is an acronym for neurocutaneous disease encompassing the expression of (P) posterior cranial fossa malformations, (H) facial haemangiomas, (A) arterial anomalies, (C) aortic coarctaion and other cardiac defects, (E) eye abnormalities and (S) for sternal malformation or stenotic arterial diseases. We report on a case of PHACE syndrome complete expression with persistent fetal vascular anomalies unusually in a 55-year-old women with large bilateral facial and neck haemangioma and posterior fossa circulation insufficiency.
Facial Vein Catheterization for Transvenous Embolization of the Cavernous Sinus
Authors: Karygiannis M.N. , Szatmary Z. , Claudino P.A. , Houdart E.
Published: January 2017

We describe three cases of transvenous embolization of arteriovenous fistulas of the cavernous sinus, achieved through the facial vein approach.

The facial vein was catheterized from a jugular vein access. This cervical approach offered good stability to the guiding catheter that permitted us to negotiate difficult curves of the facial vein and to recanalize venous thrombosis in one case.
A Double Catheter Technique for Elongated Middle Cerebral Artery Bifurcation Aneurysm
Authors: Kwon S.C. , Shin Y.S. , Kim H.S. , Kim S.Y.
Published: January 2017

We report a case of an elongated middle cerebral artery bifurcation aneurysm which was managed using an endovascular double catheter technique. After positioning two microcatheters, one at the distal dome and the other at the proximal dome, two coils were subsequently deployed through each microcatheter. We created a proximal supporting coil frame using one microcatheter and preserved the parent artery, and then deposited subsequent packing coils at the distal aneurysm sac region using the other microcatheter. The proximal framing coils did not detach prior to obtaining satisfactory aneurysm packing through the distally positioned microcatheter. This approach allowed for the proximal coil to be withdrawn if there was any evidence of the proximal coil frame changing shape or of parent artery protrusion. This double microcatheter technique provided safe and effective treatment of an elongated middle cerebral artery bifurcation aneurysm.
Traumatic Aneurysm of the Superior Cerebellar Artery
Authors: Gjertsen Ø. , Nakstad PHJ , Pedersen HKR , Josefsen R.
Published: January 2017

Following a head trauma in a 40-year-old male, massive subarachnoid hemorrhage and fractures of the skull base/clivus was found at CT. CT angiography demonstrated an aneurysm on the proximal part of the right superior cerebellar artery. The aneurysm was successfully coiled without any complication and the patient improved clinically during the following three months. The decline in use of angiography in head trauma patients during the last two decades may lead to a lower detection of traumatic aneurysm than in previous times. The value of angiographic procedures in patients suffering head traumas with SAH and skull base fractures is therefore emphasized.
Middle Meningeal Arteriovenous Fistula and its Spontaneous Closure
Authors: Chandrashekar H.S. , Nagarajan K. , Srikanth S.G. , Jayakumar P.N. , Vasudev M.K. , Pandey Paritosh
Published: January 2017

Middle meningeal artery pseudo-aneurysms and arteriovenous fistulas are usually post-traumatic, although occasional iatrogenic cases have been reported. The treatment has been obliteration of the fistula by surgical or endovascular means. Spontaneous closure of fistula is uncommon. We report a case of non-traumatic middle meningeal arteriovenous fistula in a patient with alcoholism, which resolved spontaneously without treatment.
Results of Endovascular Management for Mid-Basilar Artery Aneurysms
Authors: Zhang J. , Zhang R. , Wu Z. , Lv X. , Liu B.
Published: January 2017

We evaluated the results of endovascular management of patients with mid-basilar artery aneurysm (mBAA).

During a seven year period, 14 patients (mean age 39.6 years, male/female ratio 1:1) with mBAA were treated with endovascular techniques at our institute. Pretreatment clinical grades were determined using the Hunt-Hess scale. Outcome was evaluated using the Glasgow Outcome Scale scores (GOS) during a mean follow-up period of 15.6 months (range, three to 70 months).

Fourteen patients with 15 mBAAs were treated endovascularly. Four (28.6%) patients died of rebleeding within one day after embolization. In ten mBAAs, immediate postprocedural angiograms showed that complete occlusion was achieved, subtotal occlusion in one, and incomplete occlusion in four. Follow-up angiographic results in ten patients confirmed complete occlusion of 11 aneurysms. Long-term outcome was good (GOS Score 4 or 5) in ten patients (71.4%) and fatal (GOS Score 1) in four (28.6%).

Favorable overall long-term outcome can be achieved in 78.6% patients with mBAAs. Endovascular management of mBAAs is an effective treatment in the long-term. In our experience, the natural history of mBAAs is dismal.
Fusiform Lenticulostriate Artery Aneurysm with Subarachnoid Hemorrhage: The Role for Superselective Angiography in Treatment Planning
Authors: Kochar P.S. , Morrish W.F. , Hudon M.E. , Wong J.H. , Goyal M.
Published: January 2017

Aneurysms of the lenticulostriatal perforating arteries are rare and either involve the middle cerebral artery-perforator junction or are located distally in basal ganglia. We describe a rare ruptured fusiform lenticulostriatal perforating artery aneurysm arising from a proximal M2 MCA branch, discerned on superselective microcatheter angiography, presenting solely with subarachnoid hemorrhage (SAH).

A 50-year-old previously healthy man presented with diffuse SAH and negative CT angiogram. Cerebral angiogram demonstrated a 2 mm fusiform aneurysm presumably arising from the right lateral lenticulostriate perforator but the exact origin of the perforator was unclear. Superselective angiography was required to precisely delineate the aneurysm and its vessel of origin and directly influenced treatment planning (surgical trapping).

Superselective microcatheter angiography provides both an option for endovascular therapy as well as more accurate delineation for surgical planning for these rare aneurysms.
Transarterial Embolization of Traumatic Carotid-Superior Hypophyseal Arterial Cavernous Fistula
Authors: Wang Q. , Chen G. , Song D. , Leng B.
Published: January 2017

A 26-year-old man presented with symptoms of progressive bilateral exophthalmos and swelling of the eyelids after a severe head injury. Angiography confirmed a direct carotid-superior hypophyseal arterial (SHA) cavernous fistula with petrosal sinus and intracavernous sinus drainage. Successful transarterial coil embolization of the fistula was performed with resolution of the patient's symptoms. To our knowledge, post-traumatic arteriovenous fistula between SHA and the cavernous sinus has not been previously reported. We hereby demonstrate an effective, minimally invasive method of occluding a rare fistula by transarterial embolization.
Spontaneous Closure of a Type 2a Dural Arteriovenous Fistula following Late Recanalization of the Occluded Sinus
Authors: Warren D.J. , Craven I. , Romanowski C.A.J. , Coley S.C.
Published: January 2017

We describe the rare spontaneous resolution of a type 2a dural AVF that coincided with recanalization of the previously thrombosed sigmoid sinus after ten years of conservative management. The factors potentially responsible for spontaneous fistula obliteration are discussed and the therapeutic implication of this observation is considered.
Radiosurgery following Embolisation and/or Surgery of Brain AVM's
Authors: Killer M. , Kitz K. , Griffitt W. , Bavinzski G. , Gruber A. , Richling B.
Published: January 2017

A series of 45 patients who have undergone combined treatment for cerebral arteriovenous malformations (AVM's) is presented. All patients underwent additional radiosurgery after endovascular and/or surgical treatment. Stereotactic radiosurgical treatment using the Gamma knife has been available in our institution since 1992.

The treatment strategy for brain AVM's has changed since that time. The possibility for total cure of partially embolised AVM's, where other treatment options had been exhausted, increased with adjunctive radiosurgery. Complex or giant AVM's in eloquent areas can now be treated using radiosurgery after embolisation and/or microsurgery, with minor risk of neurological deficit.

In all 45 patients treated since September 1992 at the University of Vienna, embolisation was performed to reduce the size of the nidus in order to facilitate surgical resection or radiosurgical treatment.

In 37 patients radiosurgery was performed after endovascular treatment only, and in 8 patients radiosurgery was performed after embolisation and surgery. All AVM's were classified according to Spetzler's Grading System. 31 patients (68.9%) were classified as Grade 3 or 4. Two patients (4.5%) were classified as Grade 5.

In a mean follow up time of 16 months (range 2–40), there were 15 complete obliterations and 2 patients with unexpected residual AVM after two years.

Of patients who required staged radiosurgical therapy, 12 have been followed for less than two years after their final procedure. In an additional 12 patients the follow-up period is less than 12 months. 4 patients were lost to follow up. There is a morbidity of 8.8% and no mortality in this patient group.
Aneurysmal Disease in Children
Authors: Lasjaunias P.L. , Campi A. , Rodesch G. , Alvarez H. , Kanaan I. , Taylor W.
Published: January 2017

Twenty children (13 males, 7 females), referred to our group with non traumatic intracranial aneurysms between 1978 and January 1997, were included in this study.

Their angiograms were reviewed to assess number, location, type of aneurysms and evolution before and after treatment.

Their ages ranged from 1 month to 15 years. Seven patients (35%) presented with subarachnoid haemorrhage (SAH). Eleven patients (55%) presented with focal neurological deficits or seizures: epileptic seizures occurred in five patients, neurologic deficits or focal symptoms due to mass effect occurred in six.

Total number of diagnosed intracranial aneurysms was 24. The most common sites involved were internal carotid (37%) and vertebrobasilar (32%) systems. The aetiology of the aneurysms was infective in four patients and unknown in the remaining 16 patients (80%). Endovascular treatment was successful in seven patients (37%).

Three patients (15%) were surgically treated. Seven patients (35%) were conservatively treated. Two patients (10%) had spontaneous thrombosis of the aneurysm. SAH was more frequent in males, and never occurred in children under five years old. Frequent presentations such as focal symptoms or mass effect and less prevalence of aneurysm rupture are probably due to the high prevalence of large or giant aneurysms (25%) in our series.

In conclusion, radiological findings and the natural history of symptomatic arterial aneurysms in children are clearly different from those in adults.

Probably pathogenetic factors and aetiology are also different. Shear stresses, haemodynamic and hormonal factors do not appear to be dominant to reveal such defects, though their correction favours repair.

Since repair is frequent, conservative treatment has a major role in their aneurysm management.
The Anterolateral Transpetrosal Approach to the Clivus and the Pons
Authors: Fournier H.-D. , Pasco-Papon A. , Mercier P. , Menei P. , Hayek G. , Guy G.
Published: January 2017

Resection of skull base tumors is a real challenge in the field of neurosurgery. Anterior petrosectomy gives one of the best approaches to reach the clivus and the pons while avoiding cerebral retractions which are responsable for postoperative complications.

Using a subtemporal extradural or an infratemporal preauricular route, the anterolateral transpetrosal approaches produce a resection of the anterior pyramidal bone around the petrous carotid artery.

These approaches offer a direct view of the posterior fossa dura between the two petrosal sinuses, to give access to the petroclival area.

However, exposure of the intradural structures in the foramen magnum area is always restricted because of the inferior petrosal sinus. Its peroperative hemostasis is always truly challenging on account of its size and encasement within a wide petrooccipital suture.

The goal of the preoperative embolisation of the inferior petrosal sinus, whenever possible, is to allow its peroperative section without haemorrhage for a wider exposure along the lower clivus.