bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Intracranial Venous Occlusive Disease with Sigmoid Sinus Angioplasty and Stent Placement in a Case of Infantile Multifocal Dural Arteriovenous Shunts
Authors: Vilela P. , Willinsky R. , terBrugge K.
Published: January 2017

The infantile dural arteriovenous shunts are multifocal involving different dural sinuses and progress to an occlusive venopathy with sigmoid sinus and/or jugular bulb stenosis and subsequent occlusion. We report a successful angioplasty and stent placement of a sigmoid sinus — jugular bulb stenosis due to venous occlusive disease in a patient with infantile dural arteriovenous shunts.

A five-year-old patient presented with status epilepticus due to severe venous congestive encephalopathy. The angiogram revealed multifocal dural arteriovenous shunts, occlusion of the right sigmoid sinus, absence of cavernous sinuses and significant stenosis of the left sigmoid sinus — jugular bulb.

By transvenous approach, percutaneous transluminal balloon angioplasty and stent placement of the stenosed left sigmoid sinus — jugular bulb segment was performed. This resulted in a significant decrease of the venous pressure gradient across the stenosis and allowed a dramatic clinical recovery.

Dural sinus angioplasty and stent placement appears to be a safe and effective procedure and should be considered in the treatment of the venous occlusive disease associated with infantile dural arteriovenous shunts.
Formation of a Liquid Jet by Interaction between a Laser-Induced Bubble and a Shock Wave
Authors: Hirano T. , Komatsu M. , Ezura M. , Uenohara H. , Takahashi A. , Takayama K. , Yoshimoto T.
Published: January 2017

There are some problems such as a narrow therapeutic time window and severe side effects of fibrinolytics in the therapy of cerebral embolisms. Therefore, it is necessary to develop a new method to remove a cerebral thrombus more rapidly with fewer fibrinolytics.

A Q-switch pulsed holmium (Ho): YAG laser with 86 mJ/pulse, pulse duration of 200ns and wavelength of 2.1 mm was used. The laser beam was transmitted through a 0.6 mm diameter quartz optical fiber. Experiments were conducted in a stainless steel container equipped with observation windows. The test chamber was filled with distilled water at 283K. At first, the formation of laser-induced bubbles in a 4 mm diameter glass tube was observed. The bubble gradually expanded and reached a maximum size at about Ims after irradiation. A shock wave induced by ignition of silver azide pellet was interacted with it at 500μs before Ho: YAG laser irradiation, which resulted in forming a liquid jet. This liquid jet penetrated into an artificial thrombus made of gelatin, and its maximum penetration depth was 4.2 mm, which was nearly twice deeper than the laser irradiation only (2.2 mm).

Combination of this liquid jet and fibrinolytics will realize more rapid recanalization with fewer drugs.
Palmaz Stent Deployment for Subclavian and Brachiocephalic Arterial Occlusive Disease
Authors: Nakagawa H. , Kichikawa K. , Takayama K. , Sakamoto M. , Wada T. , Taoka T. , Fukusumi A. , Iwasaki S. , Uchida H. , Sakaki T.
Published: January 2017

Palmaz stent deployment is a useful method for subclavian and brachiocephalic arterial occlusive disease. We evaluated restenosis or intimal thickening after Palmaz stent deployment for nine lesions of subclavian or brachiocephalic arterial occlusive disease focusing on stent diameter, atheroma thickness near the stent, and degree of coverage for the lesion. Follow up DSA and IVUS at 5–14 months (mean 9) after therapy showed no significant changes in the size or shape of the stent itself. There were two lesions of thin in-stent intimal hyperplasia and five lesions of thick hyperplasia.

There was no close relationship between intimal hyperplasia and stent diameter or atheroma size (relative thickness). There was some relationship between the degree of coverage of the lesion by the stent and degree of intimal hyperplasia, but to determine statistical significance, accumulation of a greater number of cases is necessary.
Clearance of Subarachnoid Clots after GDC Embolization for Acutely Ruptured Cerebral Aneurysm
Authors: Kobayashi S. , Satoh A. , Koguchi Y. , Wada M. , Tokunaga H. , Miyata A. , Nakamura H. , Watanabe Y. , Yagishita T.
Published: January 2017

It is apparent that subarachnoid clots play an important role in the development of delayed vasospasm that is one of the major causes of mortality and morbidity in patients with acutely ruptured cerebral aneurysm. The purpose of this study is to compare the clearance of subarachnoid clots in the acute stage after the treatment with Guglielmi detachable coils (GDC) and after treatment with direct surgery.

Forty-nine patients were treated by GDC embolization within four days of the ictus. After GDC embolization, adjunctive therapies, such as ventricular and/or spinal drainage (67%), intrathecal administration of urokinase (41%), continuous cisternal irrigation (16%), and external decompression (16%), were performed. Seventy-four surgically treated patients were subsequently treated by continuous cisternal irrigation with mock-CSF containing ascorbic acid for ten days. The clearance of subarachnoid clots was assessed by the Hounsfield number serial changes on the CT scans taken on days 0, 4, 7, 10 after subarachnoid hemorrhage.

The incidence of symptomatic vasospasm was lower in the GDC group (6%) than in the surgery group (12%). The clearance of subarachnoid clots from both the basal cistern and the Sylvian fissure was more rapid in the GDC cases than in the surgery cases in the first four days. Intrathecal administration of urokinase accelerated the clearance significantly.

GDC embolization followed by intrathecal administration of thrombolytic agents accelerates the reduction of subarachnoid clots and favorably acts to prevent delayed vasospasm.
Hemodynamic Changes in Drainage Systems following Treatment of Cerebral Arteriovenous Malformations
Authors: Miyachi S. , Negoro M. , Okamoto T. , Otsuka G. , Suzuki O. , Sahara Y. , Yoshida J.
Published: January 2017

The authors studied 61 patients undergoing effective embolization for cerebral arteriovenous malformations (AVMs) and analyzed the hemodynamic changes in their drainage systems following embolization.

The changes were classified into following 5 types: type A, disappearance of all the draining veins; type B, disappearance of a part of the cortical veins; type C, disappearance of a part of the deep-seated veins; type D, combined type B and C patterns; type E, disappearance of reflux into normal cortical veins. Each case was evaluated on the basis of these criteria from comparing pre- and post-embolization angiograms.

The delay and reduction of shunt were observed in all cases. Forty-nine of them showed obvious hemodynamic changes in the draining systems including type A change in 9, type B in 19, C in 5, D in 3 and E in 13 cases, respectively. Two cases showed a spontaneous shift in the dominance of the main drainers. Thirteen of 15 cases showing successful results in subsequent radiosurgery exhibited various changes in draining pattern.

Changes in drainage systems may be affected by the compartmentalization of the nidus, reduction in shunt flow, and spontaneous or progressive thromboses. These can be promoted by embolization and may be regarded as one of the indicators of successful pretreatment for radiosurgery.
Vein of Galen Aneurysms
Authors: Komiyama M. , Nakajima H. , Nishikawa M. , Yamanaka K. , Iwai Y. , Yasui T. , Morikawa T. , Kitano S. , Sakamoto H. , Nishio A.
Published: January 2017

Eleven patients with so-called “vein of Galen aneurysms” are reported, six of whom presented with vein of Galen aneurysmal malformations (four with choroidal type and two with mural type malformations). The remaining five patients presented with vein of Galen aneurysmal dilatations secondarily due to an arteriovenous malformation in one patient, an arteriovenous fistula in another, dural arteriovenous fistulas in two patients, and a varix in another. Treatments for these patients were individualised with consideration given to the clinical manifestations and the angioarchitecture of their lesions. Endovascular Intervention played a critical role in the treatment of these vein of Galen aneurysms.
Angiographical Follow-up Results of Cerebral Aneurysms Treated by Guglielmi Detachable Coil System
Authors: Hyogo T. , Kataoka T. , Hayase K. , Nakamura H.
Published: January 2017

To examine the long term results of endovascular treatment of cerebral aneurysms with the Guglielmi detachable coil (GDC) system, follow-up (F/U) angiography was performed at 6, 12 and 24 months after the procedure. We analyzed 45 cases, 49 procedures of GDC treated cerebral aneurysms from 1997.6. to 2000.5. Follow-up angiography was achieved at 6M 43/45 (96%), 12M 29/33 (87%) and 24M 22/25 (88%). Angiographical changes were found 23/43 (53%) of the cases at 6M F/U. There were angiographical improvements in 12 cases (CP: complete occlusion, NR: neck remnant, PA: partial occlusion, PA-CP; 8, NR-CP; 1, PA-NR; 3) and angiographical worsening in 11 cases (CP-NR; 5, CP-PA; 3, PA-PA; 3) at 6M F/U. Two cases had been demonstrating progressive angiographical worsening at 6M and 12MF/U (CP-NR-PA). No angiographical change was found at 24MF/U. There was no case of hemorrhage or re-hemorrhage after GDC treatment. In cases of side-wall aneurysm, tight packing of the inflow side of the aneurysm and small neck aneurysm were thought to be causes of the angiographical improvements. In patients with wide neck aneurysms with partial occlusion result were angiographic worsening at the F/U. Other factors of angiographical worsening were improper working angle at the procedure and improper follow-up angle at the angiography and the intraluminal clot in the case of ruptured aneurysm.
Glubran 2®: A New Acrylic Glue for Neuroradiological Endovascular Use
Authors: Leonardi M. , Cenni P. , Simonetti L. , Bozzao A. , Romano A. , Bonamini M. , Fantozzi L.M. , Fini G.
Published: January 2017

Two Landrace Large White swine underwent angiography by the femoral route.

In both cases, the superior left renal artery was embolized by injection of 2 ml of Glubran 2®, diluted with Lipiodol 1:1 thereby excluding the superior left kidney poles from blood flow.

During the follow-up period, neither pig presented any clinical symptom correlated to the embolization procedure. Case 1 was sacrificed after 30 days and case 2 after 60 days. Macroscopic and microscopic analysis was performed in both animals.

Long-term follow-up of the two cases after endovascular injection of Glubran 2® showed that the embolization procedure was well-tolerated by the swine in terms of clinical symptoms and histological findings. Arterial occlusion was stable and a reasonable quantity of scar tissue appeared between 30 and 60 days, surrounding the ischaemic tissue. This follow-up experimental study offers further evidence that Glubran 2® is a safe embolizing material for human use as far as its chemical activity is concerned.
Simultaneous Bilateral Vertebral Artery 3D Rotational Angiography: Technical Report of Two Cases
Authors: Reavey-Cantwell J. F. , Lewis S. B. , Firment C.
Published: January 2017

We describe the first reported use of simultaneous bilateral vertebral artery rotational angiography to visualize an aneurysm.

Images acquired from 3D rotational angiography with a single vertebral injection provided insufficient anatomic detail in two cases with vertebrobasilar junction aneurysms associated with fenestration. Therefore, simultaneous bilateral vertebral artery 3D rotational runs were performed.

Anatomic detail was superior with the simultaneous injection and this allowed for the appropriate plan of care to be instituted. In the rare cases of vertebrobasilar junction aneurysm associated with fenestration, simultaneous bilateral vertebral artery 3D rotational angiography may provide the most useful anatomic detail when evaluating a patient for possible endovascular intervention.
Application of the Liquid Coil as an Embolic Material for Arteriovenous Malformations
Authors: Kurata A. , Suzuki S. , Ozawa H. , Yuzawa I. , Yamda M. , Fujii K. , Kan S. , Kitahara T. , Ohmomo T. , Miyasaka Y.
Published: January 2017

The purpose of this paper is to clarify advantages and disadvantages of platinum liquid coils as an embolic material for AVMs. During the last eight years, 50 endovascular procedures using liquid coils were conducted in our institute for 19 cases with AVMs, 15 of which were located in the eloquent area. All but one presented with haemorrhage, the exception demonstrating repeated ischemic symptoms. Only liquid coils were used as the embolic material to obliterate the nidus and feeders. In ten of the 15 patients with AVMs located in the eloquent area and one case rejecting surgery, liquid coil embolization was applied one to 11 times (average 3.5 times) to achieve decrease in size and this was then followed by radiosurgery. The remaining eight AVM patients underwent total removal after liquid coil embolization. No complications were encountered during the peri-embolization period. In all cases, the purpose of embolization was to diminish the size to facilitate radiosurgery and decrease bleeding during surgery.

The liquid coil has advantages as a material for embolization of AVMs; it is non-toxic and bioinart material; it seldom occludes normal minute vascular channels; when it used in a nidus, it seldom to migrates in the venous direction, and it has good radio-opacity and offers good marking for surgery. Appropriate applications include preoperative embolization or pre-radiosurgical embolization of AVMs, especially when staged embolizations are performed to reduce risk of perfusion pressure breakthrough in patients which are large or located in the eloquent area.
The Influence of Aneurysm Configuration on Intra-Aneurysmal Pressure and Flow
Authors: Sorteberg A. , Farhoudi D.
Published: January 2017

Aneurysm rupture may occur in conjunction with swift pressure increases like heavy lifting. We therefore investigated the transmission of pressure waves as well as local flow rates in various types of experimental aneurysms and their parent arteries. 0.014-inch guidewires containing a combined pressure and thermistor sensor were inserted into both the dome and the parent artery of idealized silicone aneurysms mounted in a pulsatile flow phantom. Intravascular pressure and thermodilution responses to injections of room-temperatured normal saline at a rate of 5cc.s−1 over two seconds were recorded simultaneously at both sites. Flow was evaluated semiquantitatively applying the thermodilution principle. We found that the propagation of pressure was attenuated at the dome of the aneurysms compared to their respective parent arteries. This difference was more distinct in side-wall aneurysms than in bifurcational aneurysms.

The attenuation of traveling pressure in the aneurysm was most effective at low systemic pressures. The intraaneurysmal flow rate was unique, always lower than in the respective parent arteries and highly dependent on the configuration of the aneurysm. We observed considerably higher flow rates in bifurcational aneurysms compared to side-wall aneurysms. Bifurcational aneurysms were hence characterized by a relatively high pressure transmission and high flow rates which may represent a stimulus for enlargement of untreated aneurysms and promote coil compaction in endovascularly treated lesions.
Endovascular Treatment of Incoercible Epistaxis and Epidural Cerebral Hematoma
Authors: Bortoluzzi M. , Pavia M.
Published: January 2017

A young patient with a facial trauma after a road accident was admitted to our department with incoercible epistaxis. A CT scan showed a right pterional acute epidural hematoma (EDH). Angiography demonstrated multiple sources of bleeding of the right sphenopalatine arteries, cause of the epistaxis, and an intracranial leakage of the right middle meningeal artery, responsible for the EDH. The patient immediately underwent embolization of the right internal maxillary artery and right middle meningeal artery. The procedure stopped the epistaxis and no further enlargement of the EDH was observed, avoiding its surgical treatment. Endovascular surgery may be an effective procedure to stop the arterial meningeal bleeding sustaining acute EDH and may be a useful tool in the management of special cases of post traumatic EDH.
Percutaneous Transluminal Angioplasty and Stenting for Chronic Total Occlusion of Intracranial Carotid Artery
Authors: Ishihara H. , Sakai N. , Kuroiwa T. , Sakaguchi M. , Morizane A. , Sakai C. , Yano T. , Kajikawa R. , Yamagami H. , Kobayashi J.
Published: January 2017

Chronic total occlusion of cerebrovascular lesions is regarded as a contraindication to revascularization. We describe a case of chronic total occlusion of intracranial internal carotid artery that iwass successfully recanalized by endovascular treatment.

A 72-year-old man who presented with slight right hemiparesis was proved to have chronic total occlusion of the left intracranial internal carotid artery. Percutaneous transluminal angioplasty/stenting was achieved using reversal of flow with the Parodi Anti-Embolic System. The present case indicates that percutaneous transluminal angioplasty/stenting can be an effective therapeutic option in selected patients with chronic total occlusion of cerebrovascular lesions.
Leo Stent for Endovascular Treatment of Broad-Necked and Fusiform Intracranial Aneurysms
Authors: Juszkat R. , Nowak S. , Smóal S. , Kociemba W. , Blok T. , Zarzecka A.
Published: January 2017

The advent of intracranial stents has widened the indications for endovascular treatment of broad-necked and fusiform aneurysms. Leo stent is a self-expandable, nitinol, braided stent dedicated to intracranial vessels. The aim of this study is to present our experience in endovascular treatment of broad-necked and fusiform intracranial aneurysms using self-expanding, nitinol Leo stents.

Between February 2004 and November 2006, 25 broad-necked and three fusiform aneurysms in 28 patients were treated using Leo stents in our centre. There were 18 patients who experienced acute subarachnoid haemorrhage due to aneurysm rupture, two patients who experienced SAH at least 12 months ago and in eight patients aneurysms were found incidentally. Aneurysms were located as follows: internal carotid artery, basilar artery, basilar tip, posterior inferior cerebral artery, M1/M2 segment, A2 segment and vertebral artery.

There were no difficulties with stent deployment and delivery. All patients after acute SAH (n=18) underwent stent implantation and coil embolization in one procedure. The remaining patients underwent coil embolization in a staged procedure. Immediate aneurysm occlusion of more than 95% was achieved in all patients who underwent stent placement and coil embolization in one procedure. There were three thromboembolic complications encountered in patients in an acute setting of SAH, preloaded only on acetylsalicylic acid. Use of abciximab led to patency within the stent and parent vessel. However, one of these patients presented rebleeding from the aneurysm during administration of abciximab and died.

Application of Leo stents in cases of broad-necked and fusiform intracranial aneurysms is safe and effective with a low complication rate.
Periprocedural Monitoring with Regional Cerebral Oxygen Saturation in Carotid Artery Stenting
Authors: Kamii H. , Sato K. , Matsumoto Y. , Furui E. , Ezura M. , Takahashi A.
Published: January 2017

Hemodynamic instability during and after carotid artery stenting (CAS) may reduce cerebral blood flow (CBF), leading to cerebral ischemia. To investigate changes in CBF in the periprocedural period, we continuously recorded the regional cerebral oxygen saturation (rSO2) using near-infrared spectroscopy.

In 46 consecutive patients with carotid artery stenosis, rSO2 was continuously recorded during and after CAS. In addition, the patients underwent SPECT to evaluate a change in CBF on the next day after CAS.

Introprocedural bradycardia (heart rate <50 bpm) occurred in 21 patients (46%) including one transient cardiac arrest. Intraprocedural hypotension (systolic blood pressure <80 mmHg) occurred in 18 patients (39%), and 16 of them showed prolonged hypotension. The rSO2 in patients with bradycardia/hypotension during CAS was significantly less than that in patients without them (p<0.01). Moreover, the SPECT on the next day after CAS demonstrated that the ipsilateral CBF in patients with bradycardia/hypotension during CAS significantly more than that in patients without them (p<0.05).

Intraprocedural hemodynamic instability resulted in a significant decrease in rSO2, leading to a possible severe cerebral ischemia. In addition, intraprocedural bradycardia/hypotension might be related with postprodedural hyperperfusion, causing the morbidity and mortality after CAS.
Transfemoral Transvenous Embolization of Dural Arteriovenous Fistulas Involving the Isolated Transverse-Sigmoid Sinus
Authors: Kiura Y. , Ohba S. , Shibukawa M. , Sakamoto S. , Okazaki T. , Kurisu K.
Published: January 2017

Dural arteriovenous fistulas involving the transverse-sigmoid sinus (T-S dAVFs) are sometimes isolated because this affected sinus is often thrombosed. It is difficult to perform to microcatheter cannulation to the isolated sinus through the thrombosed portion. We are now treating these T-S dAVFs by transfemoral transvenous embolization via the ipsilateral side even if the affected sinus is thrombosed and isolated or not. We use a triaxial system (6 Fr. guiding catheter / 4 Fr. diagnostic catheter / microcatheter) to emphasize the pushability and handling of the microcatheter. And we insert 4 Fr. Catheter into the affected sinus. So we can perform microcatheter cannulation into the isolated and affected sinus for treatment by coil embolization with various detachable coils.
Mechanisms of Perianeurysmal Edema following Endovascular Embolization of Aneurysms
Authors: Tomokiyo M. , Kazekawa K. , Onizuka M. , Aikawa H. , Tsutsumi M. , Ikoh M. , Kodama T. , Nii K. , Matsubara S. , Tanaka A.
Published: January 2017

After coil embolization for an aneurysm, edema surrounding the aneurysm revealed by magnetic resonance imaging (MRI) is rarely seen and is usually associated with neurological symptoms. Perianeurysmal edema was found by postoperative MRI in three out of 182 patients with cerebral aneurysm, which was treated with Guglielmi Detachable Coil (GDC), and neurological symptoms developed simultaneously.

In cases where neurological symptoms improved with conservative medical treatment, a temporary increase in the volume of an aneurysm, due to coil and thrombus formation, may result in edema. In cases where symptoms were not alleviated with conservative medical treatment, persistent water-hammer effect against the residual lumen of the aneurysm as well as an increase in the volume of aneurysm by hemorrhage in the aneurysmal wall may contribute to the development of perianeurysmal edema. Consideration of the mechanism of edema development by neurological symptoms, MRI findings, and angiographic findings is needed in order to select appropriate treatment.
Patterns of the Cranial Venous System from the Comparative Anatomy in Vertebrates
Authors: Aurboonyawat T. , Pereira V. , Kring T. , Toulgoat F. , Churojana A. , Lasjaunias P.
Published: January 2017

Comparing the adult submammalian brain with the human embryonic brain, some patterns of venous drainage are quite similar. The veins lying on the lateral surface of the brain in sub-mammals resemble those of the human embryo. In addition, the new longitudinal venous anastomosis ventral to the brain vesicles occurring late in human embryonic development seems to be similar to the late appearance of the basal vein and the ventral brain stem venous plexus found in adult mammals including man. The evolution of the new structures of the brain vesicles throughout the vertebrate series may have an induction role on the appearance of the cranial venous system.

This part of the article series focuses on the evolution of the lateral-ventral venous system of the five brain vesicles. Nevertheless, the limitation of this article is due in part to the paucity of circumstantial papers and different names used for the veins.
Preliminary Experience of Cerecyte Coils in the Treatment of Intracranial Aneurysms
Authors: Leonardi M. , Dall'Olio M. , Vasquez O. Ortiz , Quercetti C.
Published: January 2017

Coil embolization of intracranial aneurysms is the first choice treatment in many centres worldwide. The ISAT study reported in favour of endovascular treatment even though coil embolization carries a higher risk of revascularization than surgical clipping. Bioactive coils boosting fibrosis within the aneurysm and neointimal production could counteract the tendency of embolized aneurysms to re-open. We reviewed our cohort in a retrospective study based on the following inclusion criteria: 1) Cerecyte coils (Micrus Endovascular, San Jose, Calif) were the only bioactive coils deployed. 2) Cerecyte coils were used in the first embolization procedure.

Between July 2005 and December 2007 39 patients matched these inclusion criteria, 15 men and 24 women (average age 63.5 years) with 44 aneurysms. Treatment outcomes were: 30 aneurysms completed excluded from the circulation, 13 aneurysms almost completed excluded from the circulation, one incomplete aneurysm occlusion. Two aneurysms out of 44 recurred during follow-up (4.54%) and were re-embolized.

The radio-opacity and conformational memory of the Cerecyte coils were satisfactory and they were easy to manoeuvre and detach.
Dural Arteriovenous Fistula at the Anterior Condylar Confluence
Authors: Miyachi S. , Ohshima T. , Izumi T. , Kojima T. , Yoshida J
Published: January 2017

We reviewed the records of eight patients with a dural arteriovenous fistula (DAVF) close to the hypoglossal canal and determined the angioarchitecture of the clinical entity at the anterior condylar confluence.

Eight patients with DAVF received endovascular treatment at our institute over the past five years. Imaging with selective three-dimensional angiography and thin-slice computed tomography were used to identify the fistula and evaluate the drainage pattern.

Based on the angiographic findings, the ascending pharyngeal artery was the main feeder in all cases, and the occipital, middle meningeal, posterior auricular, and posterior meningeal arteries also supplied the DAVF to varying degrees. Contralateral contribution was found in five patients. The main drainage route was the external vertebral plexus via the lateral condylar veins in four patients, the inferior petrosal sinus in three patients, and the internal jugular vein via the connecting emissary veins in one patient. Selective angiography identified the shunt point at the anterior condylar confluence close to the anterior condylar vein. Shunt occlusion with transvenous coil packing was performed in all cases; transarterial feeder embolization was also used in three patients. Two patients treated with tight packing of the anterior condylar vein developed temporary or prolonged hypoglossal palsy.

Based on our results, the main confluence of the shunt is located at the anterior condylar confluence connecting the anterior condylar vein and multiple channels leading to the extracranial venous systems. To avoid postoperative nerve palsy, the side of the anterior condylar vein in the hypoglossal canal should not be densely packed with coils. Evaluating the angioarchitecture using the selective three-dimensional angiography and tomographic imaging greatly helps to determine the target and strategy of endovascular treatment for these DAVF.
Endovascular Treatment for Dural Arteriovenous Fistula of the Anterior Condylar Confluence Involving the Anterior Condylar Vein
Authors: Abiko M. , Ikawa F. , Ohbayashi N. , Mitsuhara T. , Ichinose N. , Inagawa T.
Published: January 2017

Anterior condylar confluence (ACC) dural arteriovenous fistula (AVF) is a rare anomaly. We describe two cases of ACC dural AVF involving the anterior condylar vein that were successfully treated with selective transvenous coil embolization.

The first patient presented with headache and right pulse-synchronous tinnitus, and demonstrated abnormal flow medial to the jugular bulb within the right hypoglossal canal on source image of magnetic resonance angiography (MRA). Arterioangiography disclosed a dural AVF in this area, supplied mainly by the meningeal branches of the bilateral ascending pharyngeal artery.

We diagnosed ACC dural AVF involving the anterior condylar vein and transvenous embolization was successfully performed. The second patient presented with right pulse-synchronous tinnitus. Views of source image of MRA and arterioangiography were similar to the first case and, again, transvenous embolization was successfully performed.

ACC dural AVF is a rare condition and knowledge of the anatomy of the venous system around the craniocervical junction is required for successful treatment.
Complete Cure of Superior Sagittal Sinus Dural Arteriovenous Fistulas by Transvenous Embolization through the Thrombosed Sinus in a Single Therapeutic Session
Authors: Toyota S. , Fujimoto Y. , Wakayama A. , Yoshimine T.
Published: January 2017

Endovascular treatment often fails to completely eliminate dural arteriovenous fistulas (dural AVFs) involving the superior sagittal sinus (SSS). We report a successful case of dural AVF involving the SSS using transvenous embolization through the thrombosed sinus in a single therapeutic session.
Operative Classification of Brain Arteriovenous Malformation
Authors: Beltramello A. , Ricciardi G.K. , Piovan E. , Zampieri P. , Pasqualin A. , Nicolato A. , Foroni R. , Sala F. , Bassi L. , Gerosa M.
Published: January 2017

The most important issue when dealing with a patient with a brain AVM is the decision whether to treat or not. Only after this decision has been made, taking into consideration a number of factors depending on both the patient and the specific type of AVM, can the best option for treatment be chosen.

An operative classification of brain AVMs, previously adopted in the Department of Neuroradiology and Neurosurgery of Verona (Italy) and published in this journal, was subjected to validation in a consecutive group of 104 patients clinically followed for at least three years after completion of treatment.

This classification, slightly modified from the original version concerning the importance of some specific items, allowed us to assess the indication to treat in each case, whatever type of treatment was offered to the patient.
A Combined Approach to Treatment of the Dissecting Middle Cerebral Artery Fusiform Aneurysm
Authors: Hrbáč T. , Drábek P. , Klement P. , Procházka V.
Published: January 2017

A fusiform aneurysm in the terminal M1 middle cerebral artery (MCA) segment was treated by a construction of a high-flow arterial extracranial-intracranial (EC-IC) bypass. Due to severe bypass vasospasms, local vasodilating agents together with percutaneous angioplasty and stent implantation were applied, but failed due to subsequent bypass occlusion. To remedy this complication a new bypass was created from a segment of the saphenous vein, followed by MCA aneurysm embolization and parent artery occlusion. One year after the surgery, the venous bypass remains patent and the aneurysm occluded, with the patient fully active, without any neurological sequelae.
Spontaneous Closure of Cerebral Dural Arteriovenous Fistulas with Direct Cortical Venous Drainage
Authors: Voormolen M. , Geens K. , Van Den Hauwe L. , Parizel P.M.
Published: January 2017

We describe two rare cases of spontaneous closure of cerebral dural arteriovenous fistulas (DAVFs) with a small nidus and draining directly in a single cortical vein with several ectasias.

Eighteen previously published cases of spontaneous closure of cerebral DAVF comprised more benign fistula types. In literature, several explanations for DAVF occlusion have been proposed. We hypothesize that, in addition to the known causes, the specific contrast medium used during the diagnostic selective angiography might have played a role in the thrombosis and subsequent fistula closure.
In Vitro Reproduction of Device Deformation Leading to Thrombotic Complications and Failure of Flow Diversion
Authors: Estrade Laurent , Makoyeva Alina , Darsaut Tim E. , Ghostine Jimmy , Kouznetsov Evgueni , Salazkin Igor , Roy Daniel , Weill Alain , Raymond Jean
Published: January 2017

Flow diverters (FDs) are increasingly used for complex intracranial aneurysms. As these self-expanding devices are deployed across an aneurysm neck, they can undergo deformations. The potential clinical consequences of FD deformations remain unclear.

We describe an immediate thrombotic complication attributed to a stereotypical stenotic deformation of an FD extremity that can occur when landing zones are of insufficient length. This case is supplemented with in vitro studies showing the relationship between i) the length of the landing zones and ii) discrepancies between the diameter of the device and recipient vessel, and the severity of FD stenosis.

In vitro, a shorter landing zone was associated with a progressive stenotic deformation of the terminal ends of all FDs studied. This deformation was more pronounced when the diameter of the device was oversized compared to the size of the recipient tube. In our clinical case, the presence of this deformation led to an immediate thrombotic complication, requiring deployment of a second stent to correct the observed stenosis. In addition, treatment failure ultimately led to a fatal rupture, a failure that can be explained by residual flows through a more porous transition zone, another characteristic FD deformation which occurs when they are oversized as compared to the parent vessel, but free to expand at the level of the aneurysm.

Proper selection of device diameter and length of the landing zone is important, and may decrease the incidence of deformation-related complications.
Susceptibility-Weighted Imaging in Carotido-Cavernous Fistulas
Authors: Harsha Kamble Jayaprakash , Basti Ram Shenoy , Kesavadas Chandrasekharan , Thomas Bejoy
Published: January 2017

This study determined the utility and accuracy of susceptibility-weighted MRI (SWI) for the detection of carotid cavernous fistulas.

We retrospectively compared SWI images in nine patients (Group 1, case group) of DSA-proved carotid cavernous fistula (CCF) and 19 DSA negative cases for CCF as a control group (Group 2). Group 1 was again sub-grouped into direct and indirect types. Using uniform region-of-interest measurements, signal intensity within the superior ophthalmic vein (SOV) and the superior sagittal sinus (SSS) were measured on magnitude images of SWI. The SOV/SSS signal intensity ratio was calculated in each case and the mean values of the two groups were compared.

Eleven SOV/SSS signal intensity ratios in Group 1 (7 unilateral and two bilateral CCF), 38 in Group 2 (both sides in 19 control subjects) were included. Median ± interquartile range of SOV/SSS ratios for Group 1, Group 2, indirect and direct type CCFs were 1.07 ± 0.43, 0.39 ± 0.23, 0.83 ±0.29, 1.4 ±0.38 respectively. Mann-Whitney test between Groups 1 and 2 was statistically significant with P<0.0001. All cases and controls were reliably distinguished with SOV/SSS signal intensity ratio of 0.64 as cut-off. Direct CCF cases had consistently higher ratios than indirect CCF. SWI was highly sensitive for detection and differentiation of both direct and indirect CCF. Only one case of corticovenous reflux was missed by SWI.

SWI is useful for detection of CCF and to differentiate between direct and indirect CCF.
Occlusion of the Internal Carotid Artery Based on a Simple Tolerance Test
Authors: Numi Y. , Berenstein A. , Setton A. , Kupersmith M.J.
Published: January 2017

In order to evaluate the safety of the internal carotid artery (ICA) occlusion based on our simple tolerance test, we reviewed 142 consecutive tolerance tests. Permanent endovascular ICA occlusion was performed on 99; a tolerance test only was performed on the remaining 43.

Our assessment consisted of: 1) angiographic evaluation of collateral circulations without and with ICA test occlusion, 2) evaluation of clinical tolerance to balloon ICA occlusion for 15–20 minutes. Complications of test and permanent ICA occlusion were retrospectively analyzed.

Complications related to test occlusion occurred in 2 cases (1.4%) without causing permanent deficits. Complications related to permanent occlusion occurred in 16 cases (16%) including 2 technical, 10 temporary (10%) and 4 permanent (4%). Complications were significantly decreased after introduction of stringent postoperative care to prevent hypotension in 1987. Since 1988, we performed 47 permanent ICA occlusion and experienced no technical, 3 temporary (6%) and no permanent complications.

Our method to evaluate tolerance to ICA occlusion is simple and safe. Reliability of the results is comparable to other more complicated methods of assessing ICA occlusion.
The Inflammatory Chemokine CXCL10 Modulates Synaptic Plasticity and Neuronal Activity in the Hippocampus
Authors: Kodangattil J.N. , Möddel G. , Müller M. , Weber W. , Gorji A.
Published: January 2017

Chemokines, a family member of cytokines, have been shown to play a major role in central nervous system inflammation. Among other chemokines, CXCR3 and its ligand CXCL10 are involved in the pathophysiology of several neuroinflammatory conditions. Most of these conditions are also associated with an increased incidence of seizure or epilepsy. Using age-matched wild-type (WT), as well as CXCR3-receptor-deficient (CXCR3-KO) mice, the present study aimed to investigate the effect of the chemokine CXCL10 and its receptor CXCR3 on synaptic plasticity as well as neuronal activities in hippocampal brain slices. Using field potential and intracellular recordings, the effect of exogenous CXCL10 on tetanus-induced long-term potentiation (LTP) as well as the neuronal spike activity was evaluated in hippocampal CA1 area. Exogenous application of CXCL10 enhanced LTP in WT mice, whereas it exerted no significant effect on CXCR3-KO mice. During intracellular recordings of spontaneous spike activity, exogenous application of CXCL10 significantly enhanced the amplitude, duration, and after-hyperpolarization of action potentials in slices obtained from WT mice compared to CXCR3-KO mice. In addition, CXCR3-KO mice exhibited a lower GABAA-mediated excitation in hippocampal CA1 neurons compared to WT mice. These data show that the inflammatory chemokine CXCL10, probably via its receptor CXCR3, modulates neuronal activity and synaptic plasticity in the hippocampus. CXCL10 may be involved in seizures observed during neuroinflammatory diseases such as meningitis and encephalitis.
Effects of a Weight-Bearing Exercise Training on Bone Mineral Density and Neuromuscular Function of Osteopenic Women
Authors: Marchese D. , D'Andrea M. , Ventura V. , Montalcini T. , Foti D. , Pujia A. , Gulletta E. , Iocco M.
Published: January 2017

This study was designed to evaluate whether a weight-bearing exercise training played 3 times a week can have benefits on bone mineral density and neuromuscular function in women with a diagnosis of osteopenia. The study enrolled 22 women aged between 45 and 65, with densitometric diagnosis of osteopenia. The participants were randomly assigned to a group of exercise (n=11) and a control group (n=11). The exercise program lasted for 45 min and consisted of a combination of strength exercises that seek to cause a mechanical osteoblastic stimulus by use of gravity, body weight, fall with antigravity reaction, in combination with exercises for the improvement of balance and coordination. The outcome measures used to assess the result on bone mass are the bone Mineralometric DEXA method for femoral head-neck region and lumbar spine and biochemical markers of bone turnover (resorption and neoformation) and for the evaluation of neuromuscular function was chosen to use surface electromyography (sEMG) as an indicator of overall activity and speed activation of lumbar paravertebral muscles and of the lower limbs antigravity muscles, stabilometric analysis and 6' Walk Test. In addition each person enrolled was given EuroQol and ICF core set of osteoporosis, respectively, to assess the quality of life, as well as activity limitations and participation restrictions associated. In the exercise group, mean values and changes in average rates for the balance, muscle strength, walking ability and quality of life, mean bone mineral content and bone turnover markers, corresponding to the assessments made at 0 (before rehabilitation intervention) and Time 1 (program ended), showed a statistically significant improvement. The results of this study demonstrate that a group rehabilitation program of exercises based on gravitational load, aimed to improve muscle strength and trophism, coordination and balance, can provide advantages of unquestionable importance, not only on the slope of increase bone mass of neuromuscular function and reducing risk of falling, but on health in general.
Patients with Mixed Cryoglobulinemia and HCV Infection, in Presence or Absence of Autoimmune Thyroiditis, Have High Serum Levels of (CXC MOTIF) Ligand (CXCL)9 and CXCL11 Chemokines
Authors: Antonelli A. , Fallahi P. , Ferrari S.M. , Frascerra S. , Corrado A. , Colaci M. , Manfredi A. , Maccheroni M. , Sansonno D. , Zignego A.L. , Centanni M. , Ferri C.
Published: January 2017

No data are present in the literature regarding chemokine (CXC motif) ligand (CXCL)9 and CXCL11 circulating levels in cryoglobulinemia associated with hepatitis C (MC+HCV), in presence/absence of autoimmune thyroiditis (AT). Serum CXCL9 and CXCL11 have been measured in 38 MC+HCV patients without AT (MCo), 38 MC+HCV patients with AT (MC+AT), and in matched controls without (control 1) or with thyroiditis (control 2). Serum CXCL9 and CXCL11 were significantly higher: in control 2 than control 1 ( p<0.05); in MCo than control 1 and control 2 ( p<0.001, for both); in MC+AT than control 1 and control 2 ( p<0.0001, for both), and than MCo ( p=0.01, for both). Our study demonstrates markedly high serum levels of CXCL9 and CXCL11 in patients with MC+HCV compared to healthy controls; in MC+HCV patients increased CXCL9 and CXCL11 levels were significantly associated with the presence of AT. Moreover, a strong relation between circulating CXCL9 and CXCL11 in MC+HCV has been shown.
Long-Term Results of Rehabilitative Management with Extracorporeal Shockwave Therapy in Rotator Cuff Disease with Partial Tears
Authors: Saggini R. , Coco V. , Di Pancrazio L. , Megna M. , Iodice P. , Bellomo R.G.
Published: January 2017

The purpose of this study is to evaluate the effects of rehabilitative approach using MJS and dynamic antigravity postural system (SPAD) with extracorporeal Shockwave therapy (ESWT) on rotator cuff syndrome associated tendon supraspinatus and infraspinatus medium tear (1–3 cm) of the tendons. In the last few years, ESWT has been proposed as an elective treatment in somatic diseases with encouraging short-term results. For this study the authors enrolled 108 patients who underwent 3 treatments with ESWT associated with 24 rehabilitation sessions over 3 weeks. Outcome measures were the VAS for pain and the Constant Murley Scale. The outcomes were measured pre-training, post-training and at 2, 4, 6 month follow-ups. Additional follow-up evaluation sessions were performed every year for 5 years by a telephone interview to evaluate changes in pain and function and the efficacy of treatment. Our study shows that the therapeutic efficacy of rehabilitative approach with ESWT in the rotator cuff syndrome with medium tears persists over time and significantly improves the patient's quality of life. The results obtained are certainly to be attributed to the biological mechanisms that ESWT are able to engage in tissues of the rotator cuff. The results seen at the conclusion of the treatment were maintained over the following years, thanks to the use of MJS and SPAD. In our opinion a conservative treatment with extracorporeal shock-wave (ESW), dynamic antigravity postural system (SPAD) and multi joint system (MJS) should be considered as an alternative and effective treatment for rotator cuff syndromes with medium tears.
Implants Inserted in Different Sites: Analysis of 390 Fixtures
Authors: Fanali S. , Lopez M. A. , Bassi M. Andreasi , Confalone L. , Elia G. , De Oliveira D. Pedreira , Carinci F.
Published: January 2017

Oral rehabilitation by means dental implants is a surgical procedure with high standards of success. Since very few reports focus on clinical success related to implant site and no report is available on a new type of implants (FMD srl, Rome, Italy), a retrospective study was performed. A total of 390 two-piece implants were inserted, 213 in females and 177 in males. The median age was 59 ± 11 (min-max 24–80 years). Two hundred and five implants were inserted in upper jaw and 185 in mandible. Three implants were lost, survival rate = 99.23%. Among the studies variables immediate loaded implants on single tooth rehabilitations (p=0.047) have a worse clinical outcome. Then peri-implant bone resorption (i.e. delta IAJ) was used to investigate SCR. Among the remaining 387 implants, 47 fixtures have a crestal bone resorption greater than 1.5 mm (SCR = 87.85). Statistical analysis demonstrated that no studied variable has an impact on clinical outcome and thus there are no differences in term of SVR and SCR by sites. In conclusion FMD implants are reliable devices for oral rehabilitation with a very high SCR and SVR.
Laser Biostimulation and Self Ligating Appliances in Orthodontics: Periodontal Remodeling
Authors: Caccianiga G. , Stanizzi A. , Zorzella P. , Crestale C. , Denotti D. , Squarzoni N.
Published: January 2017

24 patients are selected and 30 teeth in vestibular mucosae, without keratinized gingiva. No active periodontal disease (no BOP and gingival recessions). No BOP and CAL loss at the start of the orthodontic treatment. Every patient was treated with self ligating appliances (Time2/Time3, American Orthodontics). In every orthodontic session (each 30 days as average) the patient was treated with Nd: Yag laser biostimulation, for 90 seconds, with 320 micron fiber section, on utilizing the Biostimulating machine paremeters. No termical effects were produced by lasers applications. At the moment of debonding, 30 teeth involved in the research were evaluated in terms of quality and quantity of attached gingiva. BOP and CAL loss were also investigated. Every tooth considerated, at the end of orthodontic treatment showed a attached gingiva around the crown: the average of keratinized gingiva at the end of the study was 2,7 mm and the mean increasing at each month was 0,45 mm. The combination between self ligating appliances and laser's biostimulation could improve the differentiation of periodontal ligaments stem cells in fibroblasts, able to promote attached gingiva around the crown of the teeth erupted in oral vestibular mucosae.
Evaluation about Antimicrobical Activity of Silver in Orthoshield Safe-T-Tie® Ligatures Used in Orthodontic Patients
Authors: Caccianiga G. , Ordesi P. , Cambini A. , Stanizzi A. , Denotti G. , Fumagalli T.
Published: January 2017

Purpose: to value efficacy of anti microbic propriety of silver ligatures Orthoshield Safe-T-Tie® on periodontal tissues in orthodontic patients. Materials and methods: 50 orthodontic patients between 11 and 20 years old with permanent teeth were selected in this study. We evaluated periodontal health of maxillary and mandibular lateral incisors and canines at TO before the substitution of elastomeric ligatures with Orthoshield Safe-T-Tie® ligatures and at T1 (one month after substitution of ligatures). We used PI (Periodontal Index), GI (Gingival Index) and PRC-real-time to analyze periodontal health. Results: there was an improvement of gingival inflammation and a reduction of periodontal pathogens. Conclusions: Orthoshield Safe-T-Tie® ligatures improve periodontal health in orthodontic patients.