bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Capacity of the Distal Stump of Peripheral Nerve to Receive Growing Axons after Two and Six Months Denervation; An Experimental Study with Rats
Authors: Rönkkö H. , Göransson H. , Siironen P. , Taskinen H.-S. , Vuorinen V. , Röyttä M. 
Published: January 2017

Background and Aims: Peripheral nerve injury may lead to poor recovery outcome in spite of treatment with advanced microsurgical repair techniques. Delayed cross-anastomosis paradigm was used to study the axon grow to the distal nerve stump after denervation separately from the influence of prolonged axotomy in the proximal stump. Material and Methods: Left common peroneal nerve of 48 rats was transected and denervated over two or six months. There were two research groups in the study. In the regeneration group (REG) the proximal stump of acutely transected tibial nerve was sutured to denervated distal stump of common peroneal nerve. To our knowledge, this is the first study in which this group was compared to degeneration group (DEG) with both nerve ends denervated over two or six months. This comparison enabled us to study the capacity of denervated distal nerve stump to receive sprouting axons. Axon density in distal nerve stump was calculated after three or six week's follow-up periods. Results: There were no differences in the number of axon sprouts in the distal nerve stump between the denervation periods of two and six months. When compared REG and DEG groups, there was trend to higher axon densities in the REG group, although the differences were not statistically significant. Conclusions: We conclude that the capacity of distal nerve stump to receive the growing axons from the proximal nerve stump does not decrease significantly between two and six months denervation. Cross-anastomosis paradigm provides a useful tool for detailed study of the nerve transfer procedure.
Donation Education for Medical Students: Enhancing the Link between Physicians and Procurement Professionals
Authors: Essman Christian C. , Lebovitz Daniel J. 
Published: January 2017

Purpose Increasing healthcare professionals' knowledge about organ and tissue donation; the national mandates regarding referral compliance; and the effect on donors, donor families, and transplant recipients is a challenging task. Physicians not routinely involved in organ donation or transplantation are some of the most difficult professionals for organ procurement organizations to access. A course for medical students was developed to initiate the transfer of information, comfort, and familiarity with the organ and tissue donation process. Methods Discussions with a local medical school revealed that little organized education on organ and tissue donation existed. An elective course was developed consisting of 2-hour lectures, once a week for 6 weeks. Topics included an overview of tissue and organ donation, history and significance of the current crisis, determination of brain death and its role in organ donation, tissue donation, pretransplant and posttransplant processes, ethical issues, and the donor family and recipient experience. Results A thorough course proposal was presented to the medical school's Chairman of Surgery and Chairman of Transplantation. The proposal was approved for first- and second-year medical students. Conclusion Offering medical students a unique and comprehensive course may attract curious students who could become future champions for donation. This type of educational approach may significantly influence future interactions between physicians and organ procurement organizations. If more organ procurement organizations implement this type of program, the medical students' knowledge of donation will not only affect and benefit the local organ procurement organization's service area but other procurement organizations throughout the country as well.
Midterm Outcome of Partially Thrombosed Intracranial Aneurysms Treated with Guglielmi Detachable Coils
Authors: Kim S.J. , Choi I.S. 
Published: January 2017

We evaluated the results of Guglielmi detachable coil (GDC) treatment in partially thrombosed aneurysms and determined if there is high rate of recanalisation on follow-up. Among 149 treated aneurysms in 141 patients, 25 CT- or MR-confirmed partially thrombosed aneurysms were selected for evaluation. The features of thrombosed aneurysms and percentage of occlusion were analysed on initial angiograms. Follow-up angiograms, which were available in 18 cases, were evaluated for aneurysm lumen recanalisation. The recanalisation rate was compared with that of non-thrombosed aneurysms treated with GDCs. Locations of aneurysms were as follows: cavernous carotid ten; ophthalmic four; p- com. two; MCA one; A-com. one; basilar tip four; midbasilar two; PICA one. The size of the aneurysm lumen ranged from 5 to 30 mm (mean 16.8 mm) on angiograms, but on cross sectional images the size of aneurysms ranged from 13 to 70 mm (mean 24.6 mm). The extent of aneurysmal thrombosis ranged from 10 to 90 per cent (mean 46.4 per cent). On initial GDC treatment, total to subtotal occlusion was achieved in 18 cases out of 25 (72%). Of the 18 follow-up angiograms, 14 cases (77.8%) showed recanalisation ranging from 10 to 60 per cent of aneurysm size. Luminal recanalisation was due to migration (10 of 14) or compaction (4 of 14) of coil masses. In two cases, symptoms recurred in association with aneurysm recanalisation, but in no instance was haemorrhage noted. Attempts for retreatment were made in ten cases with success in six. In comparison, 14 (15.9%) out of 88 non-thrombosed cases revealed recanalisation on follow-up angiography. Midterm follow-up angiograms in partially thrombosed aneurysms treated with GDC revealed a fivefold higher rate of recanalisation than in non-thrombosed cases. Close follow-up is necessary in patients with thrombosed aneurysms treated with GDCs.
Computerized Assessment of Carotid Plaque Echogenicity before Stenting
Authors: Takahata H. , Hayashi K. , Kitagawa N. , Kaminogo M. , Koga H. , Shibata S. 
Published: January 2017

To assess the ability of transcutaneous ultrasound (US) to identify carotid atherosclerotic plaques at high risk for development of procedural strokes, the authors retrospectively analyzed the plaque echomorphology by means of gray-scale value (GSV). Both transcutaneous and intravascular US demonstrated a similar ability to characterize the atherosclerotic plaques. A case with embolic complication was proven to have had the lowest GSV in the studied cases. With computerized assessment of plaque echogenicity, pre-procedural transcutaneous US may be used to predict plaques that are associated with a high risk of distal embolization.
Adjunct Use of a Self-Expanding Stent for Treatment of Intracranial Stenosis
Authors: Fujimura N. , Yilmaz H. , Abdo G. , Lovblad K. O. , Sztajzel R. , Rüfenacht D. A. 
Published: January 2017

We present a case of a patient who received adjunct treatment with a self-expanding stent after balloon dilatation of a symptomatic stenosis of the carotid siphon. After predilatation, complementary angioplasty with a balloon-expandable stent was abolished due to lack of compliance of the delivery system. Since the vascular anatomy allows for the passage of balloon systems only, the stenosis was further dilated and a self-expanding stent was delivered to avoid the risk of complications related to dissection and vessel recoil. However, problem of in-stent stenosis remains at the long-term follow-up period.
Endovascular Treatment of Cerebral AVM: Our Experience with Onyx
Authors: Pérez-Higueras A. , López R. Rossi , Tapia D. Quiñones 
Published: January 2017

We have been using Onyx, a non-adhesive liquid polymer, to treat cerebral AVMs endovascularly since 1999. During this time we have treated 45 consecutive, unselected patients. From the outset this product brought about a change in our approach to treating this type of lesion because of the different injection behaviour observed for this material compared with the adhesive Histoacryl that had been employed until then. The object of this article is to assess the results achieved by our team using this new embolic agent, following angiographic and clinical follow-up of cases for a minimum of six months and a maximum of five years (mean: two years). We propose new categories of cerebral AVM based on the expected behaviour of Onyx within the nidus. Our appraisal indicates that we have improved our angiographic results, achieving complete occlusion of the malformation in 22% of cases and over 80-% closure in 69% of cases. The morbimortality rate for the procedure was 18%.
“Mirror-Image” Bilateral Giants: Intracavernous Carotid Artery Aneurysms
Authors: Díaz M.B. , Mercado F.C. , Plaghos L.A. Lemme 
Published: January 2017

The literature on the incidence of “mirror image” bilateral giant intracavernous aneurysms, their symptoms and their association with other entities is reviewed, with a brief comment on their evolution and treatment. A case of “mirror image” bilateral giant intracavernous aneurysms in a 76-year-old man who presented a sudden diplopia with pupillary sparing is reported. A CT scan showed parasellar images and dolichomega circle of Willis arteries that enhanced with endovenous contrast. MRI and angiography disclose bilateral aneurysms in detail, associated with an anomalous origin of the left common carotid artery and bilateral renal artery stenosis.
Successful Endovascular Occlusion of a Ruptured Distal Anterior Inferior Cerebellar Artery Aneurysm of the Caudal Trunk: Case Report
Authors: Kang H.-S. , Roh H.G. , Han M.H. , Koh Y.-C. 
Published: January 2017

We report a rare case of a ruptured distal anterior inferior cerebellar artery (possibly dissecting) aneurysm of the caudal trunk, successfully treated by endovascular occlusion. A 41-year-old man presented with sudden severe headache and drowsiness. On the day of ictus, conventional angiography was performed to make the above diagnosis, followed by endovascular occlusion of the sac and the parent artery. The patient recovered completely without any neurologic deficit after treatment. Endovascular occlusion could be a safe and effective treatment option in a case of a ruptured distal AICA aneurysm of the caudal trunk.
Endovascular Surgery for Ruptured Aneurysms with Vasospasm
Authors: Kurata A. , Suzuki S. , Niki J. , Ozawa H. , Yamada M. , Fujii K. , Kan S. , Kitahara T. , Miyasaka Y. , Ohmomo T. 
Published: January 2017

With the existence of vasospasm, it is recommended that direct clipping surgery for a ruptured aneurysm be delayed until its disappearance, but this may be associated with aneurysmal re-rupture resulting in a poor outcome for the patients. Indications for endovascular coil embolization in such cases are discussed. Since November in 2003, we have applied endovascular coil embolization in 11 consecutive patients with ruptured aneurysms and apparent vasospasm of the parent artery from two to 17 days (average: eight days) after initial subarachnoid hemorrhage. Three patients had aneurysmal re-rupture before treatment, but the other eight had only experienced the one episode of subarachnoid hemorrhage. With one exception, all endovascular procedures could be successfully performed, resulting in complete occlusion of aneurysms and remarkable dilatation of inserted spastic vessels without technical complications or aneurysmal re-rupture. For the one case of failure because of a tortuous artery, direct clipping surgery was performed after disappearance of vasospasm. Cerebral infarction occurred in four, but only one correlated with the distribution of catheterization, and neurological deficits had completely disappeared three months after the onset. This preliminary report concerning a small number of patients suggests that endovascular coil embolization is not contra-indicated for aneurysms with vasospasm requiring catheterization. A large study for confirmation is now warranted.
External Manual Carotid Compression is Effective in Patients with Cavernous Sinus Dural Arteriovenous Fistulae
Authors: Kai Y. , Morioka M. , Yano S. , Nakamura H. , Makino K. , Takeshima H. , Hamada J. , Kuratsu J. 
Published: January 2017

External manual carotid compression is a non-invasive method to treat patients with cavernous sinus dural arteriovenous fistulae (CS-DAVF). We studied a group of patients with CS-DAVF to identify factors that made cure by compression therapy possible. We treated 23 patients with CS-DAVF without cortical venous drainage or a recent decline in visual acuity by compression therapy. All were followed up by magnetic resonance angiography (MRA) at one, three, six, and 12 months after treatment and the characteristics of the imaging findings, their neurological symptoms, and the patterns of symptom improvement were examined. In group A (n=8), cure was achieved by manual carotid compression; in the other 15 patients (group B), cure was not obtained. Group B manifested significantly higher ocular pressure and a significantly longer interval between symptom onset and treatment by manual carotid compression. In group A, venous drainage was via the superior orbital vein (SOV) with/without involvement of the inferior petrosal sinus (IPS); closure of the CS-DAVF occurred within 4.1 months after the start of treatment. In three patients symptom improvement progressed steadily and gradually. The other five cured patients experienced transient worsening of their symptoms at two to four months after the start of treatment, these resolved within four to seven months Manual carotid compression was effective in patients without retrograde venous CS-DAVF drainage or a severe decline in visual acuity. The factors that rendered cure by compression therapy possible were lower ocular pressure and a shorter interval between symptom onset and the start of treatment. Venous drainage in those patients was exclusively via the SOV without involvement of the IPS.
Correlation of Head Trauma and Traumatic Aneurysms
Authors: Nakstad P. HJ. , Gjertsen Ø. , Pedersen H. KR. 
Published: January 2017

Subarachnoid hemorrhage following severe trauma to the head is relatively common. In most cases the bleed originates from superficial veins and occasionally from arteries. Following the replacement of cerebral angiography with CT in the diagnostic evaluation of head traumas fewer traumatic aneurysms have been observed. This may indicate that some traumatic aneurysms are missed if angiographic procedures are not performed in patients with severe head injury. Trauma patients admitted to our institution are submitted to CT including a bone algorithm. In case of subarachnoid hemorrhage, especially in the basal cisterns, CT- angiography is performed. Digital subtraction angiography is performed as well in cases with uncertain interpretations. During one year 81 patients were admitted with subarachnoid hemorrhage following head trauma. Thirteen (16%) of them underwent CT-angiography and in five (6.2%) with SAH in the basal cistern traumatic aneurysms were found. Four of these cases had a skull base fracture including fractures through the clivus. Four cases were embolized and one very small extradural aneurysm is still not treated. One small pericallosal aneurysm was operated. A traumatic aneurysm should always be suspected n patients with skull base fractures and subarachnoid hemorrhage in the basal cisterns.
Endovascular Treatment of Middle Cerebral Artery Aneurysms
Authors: Guglielmi G. , Viñuela F. , Duckwiler G. , Jahan R. , Cotroneo E. , Gigli R. 
Published: January 2017

The endovascular approach is described in 113 middle cerebral artery (MCA) aneurysms. The treatment failed in six cases with no adverse clinical consequences. Out of the 107 treated cases, it was possible to obtain a complete occlusion in 50 aneurysms (47%), whereas a residual aneurysm neck was observed in 54 cases (50%). Follow-up angiograms were performed in 60 cases, showing a 22% rate of further thrombosis of the aneurysm. Recanalization of the aneurysm was observed in 8% of cases, which required retreatment. The technique-related permanent morbidity rate was 9% while the mortality rate was 2%. A review of the surgical and endovascular literature is presented. The endovascular approach is particularly indicated when normal MCA branches do not arise from the aneurysm base. It must be meticulously planned in all other cases. Endovascular coil treatment of MCA aneurysms is feasible, with acceptable morbi-mortality rates.
Anatomic Results and Complications of Stent-Assisted Coil Embolization of Intracranial Aneurysms
Authors: Kim S.-R. , Vora N. , Jovin T.G. , Gupta R. , Thomas A. , Kassam A. , Lee K. , Gologorsky Y. , Jankowitz B. , Panapitiya N. , Aleu A. , Sandhu E. , Crago E. , Hricik A. , Gallek M. , Horowitz M.B. 
Published: January 2017

The purpose of this study was to evaluate and report our anatomic results and complications associated with stent-assisted coil embolization of intracranial aneurysms using the Neuroform stent. From September 2003 to August 2007, 127 consecutive patients (ruptured 50, 39.4%; unruptured 77, 60.6%) underwent 129 stent-assisted coil embolization procedures to treat 136 aneurysms at our institution. Anatomic results at follow-up, procedure-related complications, and morbidity/mortality were retrospectively reviewed. Stent deployment was successful in 128 out of 129 procedures (99.2%). Forty-seven patients presented with 53 procedure-related complications (37.0%, 47/127). Thromboembolic events (n = 17, 13.4%) were the most common complications, followed by intraoperative rupture (n = 8, 6.3%), coil herniation (n = 5, 3.9%), and postoperative rupture (n = 4, 3.1%). For thromboembolic events, acute intra-procedural in-stent thromboses were observed in two patients and subacute or delayed in-stent thromboses in three patients. Overall mortality rate was 16.5% (21/127) and procedure-related morbidity and mortality rates were 5.5% (7/127) and 8.7% (11/127) retrospectively. Patients with poor grade subarachnoid hemorrhage (Hunt and Hess grade IV or V; 25/127, 19.7%) exhibited 56% (14/25) overall mortality rate and 24% (6/25) procedure-related mortality rate. Immediate angiographic results showed complete occlusion in 31.7% of aneurysms, near-complete occlusion in 45.5%, and partial occlusion in 22.8%. Sixty nine patients in 70 procedures with 77 aneurysms underwent angiographic follow-up at six months or later. Mean follow-up period was 13.7 months (6 to 45 months). Complete occlusion was observed in 57 aneurysms (74.0%) and significant in-stent stenosis was not found. Thromboembolism and intra/postoperative aneurysm ruptures were the most common complications and the main causes of procedure-related morbidity and mortality. Patients with poor grade subarachnoid hemorrhage showed poor clinical outcomes. Since most complications were induced by stent manipulation and deployment, it is mandatory to utilize these devices selectively and cautiously. While the follow-up angiographic results are promising, further studies are essential to evaluate safety, efficacy, and durability of the Neuroform stent.
Ophthalmic Rete Mirabile: The First Angiographic Documentation of Embryonic Ophthalmic Collaterals in a Patient with Moyamoya Disease
Authors: Chung J.-I. , Weon Y.C. 
Published: January 2017

Plexiform vascular networks of the rete mirabile in humans are rare but can be observed in some vertebrates such as cobaye, cat, cow and sheep. Each set of embryonic arteries can be a potential source of these vascular networks which reconstitute the distal flows in segmental agenesis of internal carotid or vertebral arteries especially in patients with PHACE (posterior fossa malformation of the brain, facial hemangiomas, arterial anomalies, cardiac anomalies with coarctation of aorta, and eye abnormalities) syndrome. Ophthalmic rete mirabile has been found in some mammals such as camel, deer and avian species of pigeon, Hawaiian seabirds and deep-water fish of the cod other than human. We describe the first human case of ophthalmic rete mirabile confirmed on angiography in a patient with moyamoya disease. These findings are the first description in the English literature as far as we know. The clinical implications with moyamoya disease will be briefly discussed according to the embryologic development of cranial arteries.
Intraarterial and Intravenous Treatment of Transverse/Sigmoid Sinus Dural Arteriovenous Fistulas
Authors: Lv X. , Jiang C. , Li Y. , Yang X. , Wu Z. 
Published: January 2017

Transverse/sigmoid sinus (TS) is the most common location for cerebral dural arteriovenous fistulas (DAVFs). Most of them are cured by venous embolization or a combination of arterial embolization and surgery/radiosurgery. Our goal was to reconsider the endovascular treatment strategy of TSDAVFs according to the new possibilities of arterial embolization using Onyx-18. Nineteen patients with TSDAVFs were included in a prospective study between 2004 and 2007. Three of them had type I, four had type IIa, six had type IIa+b, three had type III, and three had type IV fistulas. Three presented with subarachnoid hemorrhage. The approach routes, angiographic results, complications, and clinical outcome were assessed. The mean clinical follow-up period was 32.5 months. In one patient, the DAVF had been obliterated spontaneously at ten month follow-up. Complete angiographic cure was obtained in nine cases with one case of progressive thrombosis. Of these ten cures were achieved after a single procedure in seven out of ten patients who had not been embolized previously. Three patients were cured with sinus packing with prior arterial embolization. Among these 19 patients, 15 underwent follow-up angiography which confirmed the complete cure. Partial occlusion was obtained in nine patients, one was cured after additional surgery, and one underwent radiosurgery. Hallucination occurred in one completely cured patient on day one. Based on this experience, we believe that intraarterial Onyx may be the primary treatment of choice for patients with TSDAVFs. The applicability of this new embolic agent indicates the need for reconsideration of the treatment strategy for such fistulas.
Parent Artery Occlusion for Intracranial Aneurysms
Authors: Cui Lishan , Peng Qiang , Ha Wenbo , Zhou Dexiang , Xu Yang 
Published: January 2017

Peripheral cerebral aneurysms are difficult to treat with preservation of the parent arteries. We report the clinical and angiographic outcome of 12 patients with cerebral aneurysms located peripherally. In the past five years, 12 patients, six females and six males, presented at our institution with intracranial aneurysms distal to the circle of Willis and were treated endovascularly. The age of our patients ranged from four to 58 years with a mean age of 37 years. Seven of the 12 patients had subarachnoid and/or intracerebral hemorrhage upon presentation. Two patients with P2 dissecting aneurysms presented with mild hemiparesis and hypoesthesia, one patient with a large dissecting aneurysm complained of headaches and two patients with M3 dissecting aneurysms had mild hemiparesis and hypoesthesia of the right arm. Locations of the aneurysms were as follows: posterior cerebral artery in seven patients, anterior inferior cerebellar artery in two, posterior inferior cerebellar artery in one, middle cerebral artery in two. Twelve patients with peripheral cerebral aneurysms underwent parent artery occlusion (PAO). PAO was performed with detachable coils. No patient developed neurologic deficits. Distally located cerebral aneurysms can be treated with parent artery occlusion when selective embolization of the aneurysmal sac with detachable platinum coils or surgical clipping cannot be achieved.