bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Analysis of 50 Cases of BAVM Embolization with Onyx, a Novel Liquid Embolic Agent
Authors: Song Donglei , Leng Bing , Gu Yuxiang , Zhu Wei , Xu Bin , Chen Xiecheng , Zhou Liangfu 
Published: January 2017

To report the embolization technique of using Onyx, a new liquid embolic agent, to treat cerebral arteriovenous malformations (AVMs) as well as its efficacy. 38 cases of cerebral AVMs located in eloquent area (motor, speech, visual nerve center), 9 in deep cerebral area, and another 3 cases in cerebellar hemisphere. The diameter of AVMs was smaller than 3cm in 10 cases, 3–6cm in 30 cases, and larger than 6cm in 10 cases. A 6F sheath was placed into the femoral artery after Selding's puncture. After a 6F guiding catheter was introduced into the internal carotid artery or vertebral artery, Ultraflow or Marathon microcatheter could be navigated into the nidus of AVMs. A long-slow injection of Onyx under fluoroscopic control was performed to embolize cerebral AVMs by adopting the “plug and push” technique. 10 AVM cases (20.0%) were considered to be totally occluded with Onyx in this group, 3 cases of which were found no regrowth by a 6-month follow-up. 25 cases (50%) were subtotally occluded while another 15 cases (30%) were partially embolized. Complications include: (1) severe cerebral hemorrhage occurred in three cases, two of them left hemiplegia after hematoma resection. (2) mild hemiplegia occurred in one lager frontal AVM patient. (3) mild visual deficit was left in one larger occipital AVM case. There was no severe complication in other 45 patients. Onyx has unique and distinctive superiority in treating cerebral AVMs. Nonetheless, the correct embolization technique should be learned to achieve good clinical results and to avoid complications. The long-term efficacy of Onyx embolization needs to be followed up.
Neurovascular Radiosurgery
Authors: Söderman M. , Guo W.Y. , Karlsson B. , Pelz D.M. , Ulfarsson E. , Andersson T. 
Published: January 2017

This article focuses on the treatment of neurovascular diseases, in particular brain arteriovenous malformations (BAVMs), with radiosurgery. The target group for this review is physicians who manage patients with neurovascular diseases, but are not actively engaged in radiosurgery. Radiosurgery for BAVMs is an established treatment with clearly defined risks and benefits. The efficacy of radiosurgery for dural arteriovenous shunts (DAVSs) is probably similar but the treatment has not yet gained the same acceptance. Radiosurgical treatment of cavernomas (cavernous hemangiomas) remains controversial. Well founded predictive models for BAVM radiosurgery show: The probability of obliteration depends on the dose of radiation given to the periphery of the BAVM. The risk of adverse radiation effects depends on the total dose of radiation, i.e. the amount of energy imparted into the tissue. The risk is greater in centrally located lesions. The risk of damage to brainstem nucleii and cranial nerves must be added to the risk predicted from current outcome models. The risk of hemorrhage during the time span before obliteration depends on the BAVM volume, the dose of radiation to the periphery of the lesion and the age of the patient. Central location is a probably also a risk factor.
Time Resolved 3D MRA. Applications for Interventional Neuroradiology
Authors: Stracke CP , Spuentrup E. , Reinacher P. , Thron A. , Krings T. 
Published: January 2017

The decision for endovascular treatment of cranial dural AV fistulae and angiomas and their follow-up after treatment is usually based on conventional DSA. New techniques of magnetic resonance angiography (MRA) facilitate high temporal and spatial resolution images. The purpose of this study was to evaluate the applicability and clinical use of a newly developed 3D dynamic MRA protocol on a 3T scanner for neurointerventional planning and decision-making. Using a 3T whole body scanner, a three-dimensional dynamic contrast enhanced MRA sequence with parallel imaging, and intelligent k-space readout (Keyhole and “CENTRA” k-space filling) was added to structural MRI and time-of-flight MRA in seven patients. DSA was performed in each patient following MR examination. In all patients MRA allowed the identification and correct classification of the vascular lesion. Hemodynamic characteristics and venous architecture were clearly demonstrated. Larger feeding arteries could be identified in all cases. Smaller feeding vessels were overlooked in dynamic MRA and only depicted in conventional DSA High temporal and spatial resolution 3D MRA may correctly identify and classify fistulae and angiomas and help to reduce the number of pre- or post-interventional invasive diagnostic angiograms.
Ruptured Giant Basilar Artery Aneurysm in a Comatose Adolescent: Successful Obliteration Using Intraoperative SSEP, BAER, and MEP Monitoring
Authors: Nwagwu C.I. , Mathews M.S. , Scott J.A. , Denardo A.J. , Horner T.G. 
Published: January 2017

Giant basilar aneurysms are infrequently seen in children. We present the endovascular management of an adolescent who presented comatose with pinpoint pupils due to a ruptured giant basilar trunk aneurysm. A noncontrast head CT disclosed a large prepontine lesion with brainstem hemorrhage. Catheter angiography showed a 4.5 cm irregular, fusiform basilar trunk aneurysm. With SSEP, BAER, and MEP monitoring, the patient underwent bilateral temporary vertebral artery occlusion, followed by GDC embolization of the aneurysm. Postprocedure internal carotid angiograms showed adequate blood supply to the basilar apex via patent posterior communicating arteries. On postprocedure day two, the patient was following commands. The remainder of his hospital course was uneventful. Postoperative angiograms showed no residual filling of the aneurysm. At 12 months the patient was neurologically intact and at baseline function as an honor student and follow-up angiogram showed persistent occlusion of the aneurysm from the circulation. Successful endovascular treatment has been considered a less invasive and safer alternative to surgical management of some complex vascular lesions. While most reports on reversing basilar artery flow have been carried out in awake patients with neurological examinations, this is not possible in a patient presenting in a comatose state. This report suggests that SSEPs, BAERs and MEP may be of use in such patients in safely carrying out basilar artery occlusion.
Unruptured Intracranial Aneurysms
Authors: Raymond J. , Nguyen T. , Chagnon M. , Gevry G. ,   Trial on Endovascular Aneurysm Management (TEAM) collaborative group
Published: January 2017

In the absence of level one evidence, the treatment of unruptured intracranial aneurysms is grounded on opinions. Results of the largest registry available, ISUIA (the International Study on Unruptured Intraacranial Aneurysms) suggest that surgical or endovascular treatments are rarely justified. Yet the unruptured aneurysm is the most frequent indication for treatment in many endovascular centres. In preparation for the initiation of a randomized trial, we aimed at a better knowledge of endovascular expert opinions on unruptured aneurysms. We administered a standard questionnaire to 175 endovascular experts gathered at the WFITN meeting in Val d'Isère in 2007. Four paradigm unruptured aneurysms were used to poll opinions on risks of treatment or observation, as well as on their willingness to treat, observe or propose to the patient participation in a randomized trial, using six questions for each aneurysm. Opinions varied widely among lesions and among participants. Most participants (92.5%) were consistent, as they would offer treatment only if their estimate of the ten-year risk of spontaneous hemorrhage would exceed risks of treatment. Estimates of the natural history were consistently higher than that reported by ISUIA. Conversely, treatment risks were underestimated compared to those reported in ISUIA, but within the range reported in a recent French registry (ATENA). Participants were more confident in their evaluation of treatment risks and in their skills at treating aneurysms than in their estimates of risks of rupture entailed by the presence of the lesion, the latter being anchored at or close to 1% /year. The gulf between expert opinions, clinical practices and available data from registries persist. Expert opinions are compatible with the primary hypothesis of a recently initiated randomized trial on unruptured aneurysms (TEAM), which is a benefit of endovascular treatment of 4% compared to observation over ten years. Only data from a randomized trial could provide convincing objective evidence in favour or against preventive treatment of unruptured intracranial aneurysms.
CT Guided Aspiration of a Cervical Synovial Cyst
Authors: Kostanian V.J. , Mathews M.S. 
Published: January 2017

Synovial cysts are cystic dilations of synovial sheaths with or without anatomical continuity within a joint space that occasionally involve the lumbar spine. Image-guided aspiration has been used successfully in the management of lumbar synovial cysts. Synovial cysts of the cervical spine are rare, tend to present with myelopathic symptoms, and are classically treated using operative intervention. We report a novel approach for cervical synovial cyst aspiration under CT guidance. A 66-year-old woman presented to the clinic complaining of severe pain, tingling, and dysesthesia in her right upper extremity in the C5, C6 and C7 nerve root distribution. MR imaging of her cervical spine showed a synovial cyst within the right C6-C7 neural foramen with significant compression and obliteration of the C7 nerve root. The patient underwent CT-guided aspiration of the cyst using a double needle technique, where one needle was used to open up the epidural space while another aspirated the cyst. This was followed by epidural injection of local anesthetic and steroids. Immediately after injection, the patient experienced complete relief of her right forearm pain, tingling, and dysesthesias. The patient tolerated the procedure well and there were no postprocedure complications. At four year follow-up the patient is free of any symptoms. Image-guided aspiration of cervical synovial cysts is feasible using CT fluoroscopy. Aspiration of these cysts combined with epidural steroid injection can provide long-lasting symptomatic relief in some patients.
Efficacy of Endovascular Surgery for Unruptured Internal Carotid Artery Aneurysms Presenting with Cranial Nerve Symptoms
Authors: Suzuki S. , Kurata A. , Kan S. , Yamada M. , Niki J. , Yuzawa I. , Sato K. , Iwamoto K. , Oka H. , Fujii K. 
Published: January 2017

Whether endovascular surgery is able to reduce the mass effects of unruptured aneurysms is still controversial, although some reports have suggested efficacy in cases of internal carotid artery aneurysms with cranial nerve palsy. Here we assessed outcome in a series of cases. Between April 1992 and April 2005, 18 patients with unruptured internal carotid artery aneurysms presenting with cranial nerve palsy were treated by endovascular surgery. The patients were two males and 16 females aged from 19 to 84 (mean 59.6 years). Aneurysms were located in the cavernous portion in 14, at the origin of the ophthalmic artery in one and at the origin of P-com in three. The aneurysms were all embolized using Guglielmi detachable coils, Interlocking detachable coils, Cook's detachable coils or Trufill DSC and detachable Balloons were applied to occlude the proximal parent artery. We analyzed the efficacy of endovascular surgery for such aneurysms retrospectively. The mean aneurysm size was 21.4 mm and the mean follow-up period was 57.7 months. Palsy of IInd cranial nerve was evident in three patients, of the IIIrd in eight, of the Vth and Vth in one each, and of the VIth in nine. Post embolization occlusion was complete in nine patients and neck remnant in the other seven. Regarding complications of endovascular surgery, one case (5.6%) showed TIA after embolization. Overall 11 (46%) cranial nerve symptoms showed complete resolution, eight (33%) showed some improvement, and five (21%) were unchanged. In three cases (12.5%), the symptoms worsened after treatment. The shorter the duration of symptoms was a factor predisposing to resolution of symptoms. In complete resolution cases, the timing of treatment after symptoms appeared and the time of complete resolution were in proportion. These results showed that there is no difference in reduction of mass effects between surgical clipping and endovascular surgery for unruptured internal carotid artery aneurysms. With endovascular surgery, the rapidity of treatment after symptoms is the most important factor for successful results.
Evaluation of Carotid Plaque Composition by Computed Tomography Angiography and Black Blood Magnetic Resonance Image
Authors: Haraguchi K. , Houkin K. , Koyanagi I. , Nonaka T. , Baba T. 
Published: January 2017

The purpose of this study was to evaluate the composition of a carotid plaque quantitatively by computed tomography (CT) angiography and qualitatively by black blood magnetic resonance imaging (MRI). Thirty-eight patients with high-grade carotid artery stenosis were included in this study. Ultrasonography, CT angiography and black blood MRI of the cervical carotid artery were performed, and the CT number was measured in Hounsfield units (HU). The average CT number of the 15 unstable plaques (39.5%) was 27.7 ± 7.5 HU and that of the 23 stable plaques (60.5%) was 60.4 ± 20.8 HU (p <0.0001). In the 23 patients with stable plaque, 21 demonstrated isointensity in T1 and T2 in the black blood MRI (p <0.0001). By using CT angiography and MRI, precise images of the pathology of the carotid arterial wall can be obtained. It is possible to evaluate the components of a carotid artery plaque with high reliability by quantification of the CT number in CT angiography and performing black blood MRI as well as in carotid ultrasonography.
Vascular Microanatomy of the Pontomedullary Junction, Posterior Inferior Cerebellar Arteries, and the Lateral Spinal Arteries
Authors: Mercier Ph. , Brassier G. , Fournier H-D , Picquet J. , Papon X. , Lasjaunias P. 
Published: January 2017

This study of 25 brains at the pontomedullary junction defined the different possible origins of the perforating arteries and lateral spinal arteries in relation to the posterior inferior cerebellar arteries (PICAs). - If the PICA emerges from the common trunk of the AICA-PICA coming from the basilar artery, it never gives perforating arteries or a lateral spinal artery on the lateral surface of the brain stem but supplies blood to a part of the ipsilateral cerebellar hemisphere. - If the PICA arises extradurally at C1, it never gives perforating arteries for the lateral surface of the brain stem, but it gives pial branches for the posterior surface of the medulla oblongata and is always the origin of the lateral spinal artery. - If the PICA emerges in the intradural vertebral artery, it is the source of the perforating arteries for the lateral surface of the brain stem and of the blood supply of the ipsilateral cerebellum.
Traumatic Carotid Cavernous Fistula Concomitant with Pseudoaneurysm in the Sphenoid Sinus
Authors: Huai R.C. , Yi C.L. , Ru L.B. , Chen G.H. , Guo H.H. , Luo L. 
Published: January 2017

This study was designed to elucidate the generating mechanism, diagnosis and treatment of traumatic carotid cavernous fistula (tCCF) concomitant with pseudoaneurysm in the sphenoid sinus. Six cases of tCCF concomitant with pseudoaneurysm in the sphenoid sinus were analyzed in this study. Clinical history, neurological examination, CT and MRI scans, pre- and postembolization cerebral angiograms and follow-up data were included. All patients presented with massive epistaxis and symptoms of tCCF. The pseudoaneurysms and fistulas were occluded with detachable balloons, and preservation of the parent artery in two cases. One patient also had indirect carotid cavernous fistula (CCF) on the contralateral side embolized by transfacial vein approach with microcoils. Complete symptom resolution was achieved in all cases, without procedure related complications. During the follow-up period all patients returned to work. Falling from a high speed motorcycle without wearing a helmet may be one of the main causes of this disease. The site of impact during the accident mostly localizes in the frontal and lateral of the orbit. Intracavernous sinus hypertension of tCCF combining with fracture of the lateral wall of the sphenoid may lead to the formation of a pseudoaneurysm in the sphenoid sinus. MRI scan is very helpful in the diagnosis of this disease before the patient receives angiography. Detachable balloon occlusion of the pseudoaneurysm and fistula is a safe and efficient treatment.
A Randomized Trial Comparing Platinum and Hydrogel-Coated Coils in Patients Prone to Recurrence after Endovascular Treatment (The PRET Trial)
Authors: Raymond J. , Roy D. , White P.M. , Fiorella D. , Chapot R. , Bracard S. , Kallmes D.F. ,   THE ICONE COLLABORATIVE GROUP
Published: January 2017

New coils have been designed to preserve the safety of coil embolization while improving on long-term efficacy. There is currently no scientific evidence that one type of coil material is better than another. The recurrence problem may be more pressing in certain types of patients, such as patients with large aneurysms or those already presenting with angiographic recurrences.
Unruptured Intracranial Aneurysms
Authors: Raymond J. , Guillemin F. , Proust F. , Molyneux A.J. , Fox A.J. , Claiborne J.S. , Meder J.-F. , Rouleau I. ,   The Trial On Endovascular Aneurysm Management (Team) Collaborative Group
Published: January 2017

The preventive treatment of unruptured aneurysms has been performed for decades despite the lack of evidence of a clinical benefit. Reports of observational studies such as the International Study of Unruptured Intracranial Aneurysms (ISUIA) suggest that preventive treatments are rarely justified. Are these reports compelling enough to guide clinical practice? The ISUIA methods and data are reviewed and analysed in a more conventional manner. The design of the appropriate clinical research program is approached by steps, reviewing potential problems, from the formulation of the precise research question to the interpretation of subgroup analyses, including sample size, representativity, duration of observation period, blinding, definition of outcome events, analysis of cross-overs, losses to follow-up, and data reporting. Unruptured intracranial aneurysms observed in ISUIA ruptured at a minimal annual rate of 0.8% (0.5–1%), despite multiple methodological difficulties biased in favour of a benign natural history. Available registries do not have the power or the design capable of providing normative guidelines for clinical decisions. The appropriate method to solve the clinical dilemma is a multicentric trial comparing the incidence of a hard clinical outcome events in approximately 2000 patients randomly allocated to a treatment group and a deferred treatment group, all followed for ten years or more. Observational studies have failed to provide reliable evidence in favour or against the preventive treatment of unruptured aneurysms. A randomized trial is in order to clarify what is the role of prevention in this common clinical problem.
Initial Clinical Experience with a New Biointegrative Cement for Vertebroplasty in Osteoporotic Vertebral Fractures
Authors: Siemund R. , Nilsson L.T. , Cronqvist M. , Strömqvist B. 
Published: January 2017

Polymethylmethacrylate, as a widely used material for vertebroplasty, has several drawbacks such as heat development and high allergenic potential. In order to avoid these drawbacks ceramic cement materials have been developed. The purpose of this study was to evaluate a new biointegrative material for vertebroplasty in osteoporotic vertebral fractures regarding pain relief, safety aspects and technical feasibility. The injectable bone substitute Cerament™ SpineSupport has been developed for vertebroplasty of osteoporotic vertebral fractures. The aim of the product is to provide mechanical stability by cured calcium sulfate dehydrate during a period of several weeks and to act as an osteo-conductive support by hydroxyl apatite particles. Inclusion criteria were a stable single vertebral fracture at levels Th5 to L5, verified by CT and MRI, and not older than four weeks, in osteoporotic patients aged 60 years or older. Bipedicular vertebroplasty technique was used. Follow up included CT directly after treatment and after two month and pain assessment (VAS) pre and post procedure after two weeks and one month. Seven patients (age range 62 – 96 years, mean 73.9, five women, two men) were treated at levels T 8 (n=1), T 12 (n=4) and L1 (n=2). The average injected volume was 1.9 ml (range 0.2 – 4 ml). No material or procedure-related complications were observed. An average height loss of the treated vertebral bodies of 3.6 mm (range 1.5 – 5.4) was seen two months after treatment as compared to pre-treatment CT. Pain assessment by VAS resulted in an improvement from mean 69 prior treatment to 37 the day post treatment, 42 after two weeks and 30 after one month. Initial results indicate that Cerament™ SpineSupport is safe and effective in the treatment of acute osteoporotic vertebral body fractures. Further studies with long-term follow-up are needed to confirm these results and to prove the concept of osteoconduction with hydroxyl apatite particles.
Evaluation of the Solitaire System in a Canine Arterial Thromboembolic Occlusion Model: Is it Safe for the Endothelium?
Authors: Park Soonchan , Hwang Seon Moon , Song Joon Seon , Suh Dae Chul , Lee Deok Hee 
Published: January 2017

The Solitaire system has recently been increasingly used for acute stroke treatment in which the endothelial safety immediately after its use has not been evaluated. This study was performed to evaluate the endothelial status when using a Solitaire system in a canine arterial occlusion model. Thromboembolic occlusion of both internal maxillary arteries was achieved in five mongrel dogs. In each animal, the Solitaire system (ev3, Irvine, CA, USA) was used for primary thrombectomy on the right side and for temporary stenting on the left side. Efficacy was assessed by comparing the recanalization rates, and safety was assessed using angiographic and microscopic assessments. Endothelial injuries were evaluated with light microscopy (LM) and scanning electron microscopy (SEM). Successful revascularizations were observed following primary thrombectomy in all five animals (100%) and after temporary stenting in two (40%). There was no incidence of vasospasm or vessel perforation in either group. Distal migration of the clot occurred in two animals that underwent primary thrombectomy. Endothelial injury was seen after primary thrombectomy in two animals (40%) and after temporary stenting in one (20%). The lesions presented as defects of the internal elastic lamina on LM and denudation of the wavy endothelial surface on SEM. During mechanical thrombectomy, the Solitaire system can cause endothelial injury both in primary thrombectomy and temporary stenting. Primary thrombectomy is likely to have a higher recanalization rate with increased endothelial injury.