bluuebunny/crossref_metadata_2025_split huggingface dataset:
Definitive Embolization of Meningiomas
Authors: Bateman B. T. , Lin E. , Pile-Spellman J. 
Published: January 2017

This review examines the possible role for definitive embolization as a primary therapy for intracranial meningiomas. Surgery or radiosurgery are currently considered the standard of care for most benign meningiomas. However, each of these carries substantial risks. The perioperative mortality for surgical resection, as reported in large series, is between 3.7–9.4%; these studies report a similarly high rate of new neurological deficits following surgery. The rate of complications from radiosurgery is reported between 2–16% and it may take months to years before improvement in symptoms occurs following this therapy. There are a few reports of treating meningiomas by embolization without subsequent surgery. While these studies include small numbers of patients and have limited follow-up, the initial results are very promising. Given the risks and limitations of surgery and radiosurgery, prospective trials are now needed to determine the safety and efficacy of definitive embolization.
Vertebroplasty in the Treatment of Spine Disease
Authors: Ambrosanio G. , Lavanga A. , Vassallo P. , Izzo R. , Diano A.A. , Muto M. 
Published: January 2017

We report our experience in the treatment of thoracic and lumbosacral spinal pain due to vertebral bone fractures. This pathology can be related to osteoporosis but also to metastatic disease and less frequently vertebral haemangioma. From April 2001 through December 2004 we treated 238 patients for a total of 455 vertebral bodies. 175 patients had osteoporosis, 70 had metastasis and 13 had vertebral haemangioma. Sacroplasty was performed in six patients to obtain a cement filling of sacral metastasis. The procedures were mostly performed under fluoroscopy and only in cases of metastasis or sacroplasty was CT/fluoroscopy guidance preferred for optimal filling of the area of osteolysis. We evaluated the results at six and 18 months follow-up and analysed the incidence of new vertebral fractures, vascular and disk leakage and the incidence of major and minor complications. Biopsy was performed only in doubtful cases. We obtained different results considering the etiology of the disease. We obtained a 92% success rate at six months follow-up and 89% success at 18 months follow-up in osteoporosis, a 77% and 72% success rate at six and 18 months follow-up in metastastic patients, and no change at six and 18 months follow-up in patients with vertebral haemangioma in which the success rate was of 95%. We noted extravertebral leakage in 41% of vertebral bodies of which 31% were treated at the level of the vascular space and only 10% at the level of the disk space, and symptomatic in only two cases (acute compressive radiculitis, medically treated and resolved within a month). Six patients presented new fractures in the adjacent vertebral body and 30% had a partial recovery in the height of the vertebral body with kyphosis curve reduction. Vertebroplasty is a good technique to obtain spine pain relief and has a low incidence of side effects. Good quality equipment is important to obtain these results.
Recurrent or New Symptomatic Cerebral Aneurysm after Previous Treatment
Authors: Rothemeyer S. , Lefeuvre D. , Taylor A. 
Published: January 2017

With the establishment of endovascular coiling as a successful treatment for symptomatic cerebral aneurysms, attention is now being directed at the durability of this treatment. If this is to be accurately done it will be important to understand the causes of symptomatic aneurysm presentation after previous treatment. In order to assess this we undertook a retrospective review, covering the four year period from 2000 to 2004, of all patients re-presenting with a symptomatic saccular aneurysm after previous treatment. Seven patients were identified, six presenting with subarachnoid haemorrhage (SAH) and one with a third cranial nerve palsy. Three patients had incomplete clipping of their aneurysms and all presented within months of their initial treatment. The other four patients presented between five and 20 years after primary treatment and all were felt to have new cerebral aneurysms. Two of these patients had aneurysms develop at the same location as their previously treated lesions, however these were still felt to be new aneurysms rather than re-growth or recurrence because of their morphology. Based on our findings it would appear that development of a new cerebral aneurysm after clipping is more of a risk than aneurysm recurrence from treatment failure. This will need to be considered when evaluating re-presentation after treatment by either coiling or clipping and more importantly, perhaps we should be directing more attention to preventing disease progression rather than treatment failure.
Carotid Blowout Treated by Direct Percutaneous Puncture of Internal Carotid Artery with Temporary Balloon Occlusion
Authors: Chang F.-C. , Lirng J.-F. , Luo C.-B. , Teng M.M.H. , Guo W.-Y. , Chang C.-Y. 
Published: January 2017

Direct percutaneous puncture of a cervical carotid pseudoaneurysm for coil placement or acrylic embolization is described for the endovascular management of acute carotid blowout. However, direct puncture of the internal carotid artery (ICA) for the endovascular management of carotid blowout has not been described. We report a difficult case of acute carotid blowout syndrome in a patient who had radiation-induced occlusion of the right common carotid artery with vasculopathy and pseudoaneurysm in the right cervical ICA. Collaterals from the branches of the controlateral external carotid artery (ECA) anastomosed with branches of right ECA supplied the vasculopathy. We performed direct percutaneous puncture of the bulb of the right ICA using a spinal needle and placed fiber coils to occlude antegrade flow of the artery. During the injection of a mixture of N-butyl cyanoacrylate and lipiodol oil for embolization of the remaining carotid bulb, we transiently inflated an occlusion balloon in the controlateral common carotid artery to further arrest antegrade flow in the ICA. The vasculopathy and pseudoaneurysm of the right cervical ICA were successfully embolized, with preservation of the distal branches of the right ICA.
An Experimental Aneurysm Model: A Training Model for Neurointerventionalists
Authors: Grunwald I.Q. , Romeike B. , Eymann R. , Roth C. , Struffert T. , Reith W. 
Published: January 2017

Reproducible animal models not only facilitate the pre-clinical assessment of aneurysm therapy but can also help in training for interventional procedures. The objective of this study was to find an animal model that can be used to test different endovascular occlusion techniques. Aneurysms in the right common carotid artery were created in 35 NZW rabbits by distal ligation and intraluminal elastase infusion. A total of 27 aneurysms were occluded by endovascular embolization with GDC-Coils. The time needed for placement of the microcatheter into the aneurysm by a professional interventionalist, a semi-professional interventionalist and a trainee was measured. The percentage of occlusion (occlusion rate) of the aneurysms was determined angiographically after embolization and again three months later, followed by a histological examination. Aneurysms of 2–6 mm size were reliably created in all 35 animals; mean size was 3.0 mm in height and 5.5 mm in diameter. Occlusion was achieved in 27 animals. Five animals from the group of 35 were initially planned as a control group with no embolization. We added to the control group one animal whose aneurysm could not be occluded endovascularly because of partial thrombosis and small size of the aneurysm. The angiographically determined mean occlusion rate was 89.5% ± 11.3% standard deviation. Histological evaluation of the six aneurysms of the control group showed that they remained patent. Aneurysms that underwent embolization showed organized thrombus formation with no signs of recanalization. Two animals died from anaesthesia related or embolic complications. The time needed by the professional did not significantly decrease, after a little practice the trainee was nearly as quick as the professional. The beginner showed extensive progress, reducing the time for catheter placement by more than 50%. This paper describes the angiographic and histopathologic findings and also demonstrates possible methods for training in interventional procedures. Animal models will play a vital part in the training of future interventionalists. This model has the capability of testing different embolization devices (GDC, Onyx®) and methods. Histologic long-term prognosis and the physical effect of the coils can be evaluated with this model.
Cerebral Aneurysm Perforations during Treatment with Detachable Coils
Authors: Layton K.F. , Cloft H.J. , Kallmes D.F. 
Published: January 2017

Perforation of intracranial aneurysms during endovascular treatment with platinum micro-coils is a well-known and serious complication reported to occur in 2–4% of patients. Inflation of a remodelling balloon across the aneurysm neck or within the proximal parent vessel is an additional technique that theoretically might be useful to reduce flow within the aneurysm and achieve hemostasis. In the case reports that follow, we present our experience using this technique for managing intraprocedural aneurysm rupture.
Polyurethane Stent Obstruction as a Cause of Recurrent Epiphora
Authors: Doganay S. , Sarac K. , Miman M.C. , Karadag N. , Cokkeser Y. 
Published: January 2017

A Song's nasolacrimal duct stent was placed in a patient with epiphora due to primary nasolacrimal duct obstruction and the stent was kept for 32 months. Mitomycin C 0.02% eye drops four times a day were prescribed for four weeks following polyurethane stent placement procedure. No epiphora-related complaints occurred for thirty months after then the epiphora started. Nasolacrimal stent was removed from nasal cavity endoscopially and the tissues within the extruded stent were examined histopathologically. The patient's complaints were relieved following stent removal. Dacryocystogram revealed normal passage and a filling defect within the lacrimal sac. Macroscopic evaluation of the stent revealed a firm mass in the stent mushroom, causing complete obstruction. Pathological examination of the mass revealed chronic inflammation, increased connective tissue and vascular proliferation. Nasolacrimal polyurethane stents can be removed easily by nasal approach. Nasolacrimal passage may be left open temporarily after stent removal. The use of Mitomycin C drop is a novel approach in nasolacrimal stent placement cases. However, when the long-term results of endoscopic and external dacryocystorhinostomy are considered, further research is needed on the biocompatibility of stent material.
Pseudotumor Cerebri: A New Door Opens for Treatment
Authors: Crosa R. , Marabotto O. , Meehroff G. , Legnani C. , Boschi J. , Negrotto A. , Terbrugge K.G. , Lasjaunias P. 
Published: January 2017

Pseudotumor cerebri remains a scarcely known pathology. We present the experience of a multidisciplinary working group which studied this disorder focusing on the venous alterations of the dural sinuses. Seventeen cases were studied, diagnosed, controlled and treated by our team. In one of the cases, we placed a stent in the left lateral sinus with good result. In all the patients we observed various degrees of stenosis in the brain venous sinuses quantified by pressure measurement. Nevertheless, to determine the exact cause of this pathology, more studies are necessary.
Minimally Invasive Approach for Drainage of a Sacral Epidural Abscess
Authors: Kostanian V.J. , Mathews M.S. 
Published: January 2017

Sacral epidural abscesses are rare infections, often managed with open surgery, especially in the presence of acute neurological symptoms. We report a novel approach for minimally invasive drainage of sacral epidural abscesses. A 51-year-old man presented to the emergency department complaining of low back pain, generalized muscle pain, pain across several large joints, low-grade fever, and weakness of both legs for ten days. MRI of the patient's lumbosacral spine showed osteomyelitis involving his L5, S1 vertebrae, L5-S1 discitis, as well as anterior and posterior epidural abscesses extending from L5-S1 disc space to the S2 vertebral level. Under CT fluoroscopic guidance a 20-gauge spinal needle was inserted into the sacral hiatus, parallel to the pelvic surface of the sacral canal, and directed cranially. A 0.18-gauge microwire was then advanced through the 20-gauge needle. The 20-gauge needle was exchanged over the guidewire for an 18-gauge blunt tipped needle which was curved to approximate the contours of the sacral canal. The curved needle was inserted through the sacral hiatus with its concavity initially facing upwards, and then rotated 180° to gain access to epidural abscess. Once anatomic access was established 5cc of thick purulent material was evacuated. The patient tolerated the procedure well, and no focal nerve root symptoms were noted following the procedure. Image guided aspiration of sacral epidural abscesses can be carried out in a safe and effective manner using CT fluoroscopy. Aspiration of these abscesses combined with intravenous antibiotics may be an alternative to open surgery in select patients.
Long-Term Follow-up Study of Endovascularly Treated Intracranial Aneurysms
Authors: Pyysalo L.M. , Keski-Nisula L.H. , Niskakangas T.T. , Kähärä V.J. , Öhman J.E. 
Published: January 2017

Long-term follow-up studies after endovascular treatment for intracranial aneurysm are still rare and inconclusive. The aim of this study was to assess the long-term clinical and angiographic outcome of patients with endovascularly treated aneurysms. The clinical outcome of all 185 patients with endovascularly treated aneurysms were analyzed and 77 out of 122 surviving patients were examined with MRI and MRA nine to 16 years (mean 11 years) after the initial endovascular treatment. Sixty-three patients were deceased at the time of follow-up. The cause of death was aneurysm-related in 34 (54%) patients. The annual rebleeding rate from the treated aneurysms was 1.3% in the ruptured group and 0.1% in the unruptured group. In long-term follow-up MRA 18 aneurysms (53%) were graded as complete, 11 aneurysms (32%) had neck remnants and five aneurysms (15%) were incompletely occluded in the ruptured group. The occlusion grade was lower in the unruptured group with 20 aneurysms (41%) graded as complete, 11 (22%) had neck remnants and 18 (37%) were incomplete. However, only three aneurysms were unstable during the follow-up period and needed retreatment. Endovascular treatment of unruptured aneurysms showed incomplete angiographic outcome in 37% of cases. However, the annual bleeding rate was as low as 0.1%. Endovascular treatment of ruptured aneurysms showed incomplete angiographic outcome in 15% of cases and the annual rebleeding rate was 1,3%.
Triple Coaxial Catheter Technique for Transfacial Superior Ophthalmic Vein Approach for Embolization of Dural Carotid-Cavernous Fistula
Authors: Yuen M-H. , Cheng K-M. , Cheung Y-L. , Chan C-M. , Yu S.C.H. , Wong G.K.C. , Poon W-S. 
Published: January 2017

We report a triple coaxial catheter technique to facilitate the venous access to the superior ophthalmic vein during transvenous embolization of dural carotid-cavernous fistula (DCCF) via the transfacial venous route. Two patients with transvenous embolization of DCCFs by coils were treated with transfacial superior ophthalmic vein (SOV) approach by the triple coaxial catheter technique. The triple coaxial catheter system consisted of a 6F guiding catheter as the outer catheter and a 4F guiding catheter as the middle catheter and a microcatheter as the inner catheter to help navigation and manipulation. The DCCFs were completely obliterated in both cases. There were no complications associated with the procedure. The ophthalmic symptoms of the patients had totally resolved at two-month follow-up. The triple coaxial catheter technique can be used with the transfacial SOV approach in embolization of DCCF. This technique has two advantages over the double coaxial catheter technique because it offers additional length and support for the distal navigation of microcatheter into the SOV.
Hemorrhage Rates and Outcomes When Using up to 100 mg Intra-Arterial t-PA for Thrombolysis in Acute Ischemic Stroke
Authors: Christoforidis G.A. , Slivka A.P. , Karakasis C. , Mohammad Y. , Avutu B. , Yang M. , Bourekas E.C. , Chakeres D.W. , Slone H.W. , Yuk W.T. 
Published: January 2017

This work presents a unique single center experience with intra-arterial delivery of tissue plasminogen activator (t-PA) doses as high as 100mg for thrombolysis. Hemorrhage volumes, hemorrhage rates, clinical outcomes and radiographic outcomes were assessed. Prospectively collected angiographic, clinical and laboratory information on 67 consecutive patients with acute ischemic stroke involving either the m1 segment of the middle cerebral artery, the intracranial internal carotid artery or the basilar artery were retrospectively analyzed. Patients who received more than 50 mg t-PA were compared with those patients receiving 50 mg or less. Outcome measures included: symptomatic hemorrhage, significant hemorrhage volume (greater than 25 ml), hemorrhage rate, change in National Institutes of Health stroke scale score at 24 hours and at hospital discharge, modified Rankin score at 90 days, in-hospital deaths, death within 90 days, reperfusion rate, and infarct volume. Multivariate logistic regression analysis demonstrated that t-PA dose over 50 mg was associated with higher rates of hemorrhage and larger hemorrhages. Poor pial collateral formation, poor reperfusion (less than 50% of the territory involved), and platelet count below 200 K/μL influenced hemorrhage. Limiting t-PA dose to 100mg rather than 50mg improved documented reperfusion rates from 37% to 61%. Restricting intra-arterial t-PA administration to 100mg rather than 50mg, is associated with higher overall reperfusion rates and improves overall outcomes, however, the hemorrhage rate is also elevated. Poor pial collateral formation and platelet count less than 200 K/μL may be reasons to curtail the use of higher t-PA dose to reduce hemorrhage rate.
Aneurysmal Malformations of the Vein of Galen
Authors: Lasjaunias P.L. , Alvarez H. , Rodesch G. , Garcia-Monaco R. , terBrugge K. , Burrows P. , Taylor W. 
Published: January 2017

The Vein of Galen Aneurysmal Malformation (VGAM) is regarded as a lesion with high morbidity and mortality, both spontaneously and under treatment, in part due to an incomplete appreciation of the effects of the lesion on the specific physiology of young children. In addition, various techniques have been applied over a short period of time to treat the lesion rather than the disorders it creates. We report experience with 120 consecutive cases of VGAM managed over the past ten years: 24 were diagnosed antenatally; 50 presented in the neonatal period with haemodynamic disturbance; 35 in infants presented with secondary hydrovenous disorders (macrocrania, subependymal atrophy and ventricular dilatation); 12 were seen in children. We were unable to follow 10% of the patients because the referring teams decided not to follow our therapeutic advice. Treatment was contra-indicated in 17% of cases (with early brain damage and a rapidly fatal outcome). There were five (4%) which thrombosed spontaneously (but only two of these were neurologically normal). Embolisation was performed in 78 patients via a transarterial femoral approach using glue. Anatomical cure has already been achieved in 53%. Of the treated patients, even when treatment has not been completed, 80% are growing neurologically normal. Permanent neurological deficit or irreversible neurocognitive delay related to the natural history of the lesion were evident in 8.5%. Overall mortality was 9%. These figures confirm that previous views on the prognosis of VGAM should be revised. Endoarterial embolisation, is the preferred treatment to date.
Medical Treatment of Congestive Cardiac Failure from Cerebral Arteriovenous Fistulas at Bicêtre Hospital
Authors: de Victor D. , Le Pommelet C. 
Published: January 2017

Arteriovenous fistulas create an increase in venous return and subsequent right heart overload. The result is right heart dilatation, pulmonary arterial hypertension, and increased pulmonary blood flow. Reduction in arterial diastolic pressure (as observed in arteriovenous shunt), an increase in end diastolic pressure (due to increased preload), a reduction in diastolic period (due to tachycardia) are all detrimental to myocardial perfusion and hence oxygen delivery and may precipitate left ventricular failure. Furthermore, the transition from a foetal circulatory pattern to an adult circulatory pattern is complex and both pulmonary and systemic circulations remain highly unstable during the first week after birth. This can explain a persistent transitional circulation with shunts through the ductus arteriosus, the foramen ovale and a pulmonary hypertension which worsen the systolic and diastolic wall stress. The clinical presentation depends on the size of the left-to-right shunt and its tolerance. The aims of symptomatic therapy are to improve oxygen delivery to the tissues and decrease tissue oxygen consumption. Measures that improve the patient's effective ventilation, arterial oxygen saturation, and hematocrit need to be the first steps. Diuretics are the first step for reducing preload. Cardiac output can be improved by increasing cardiac contractility with inotropic agents. Digoxin is the main agent used to increase myocardial contractility. However, its use in a hyperkinetic state due to arteriovenous fistulas remains controversial: pretreatment myocardial function indices may already be above normal, and there is no clear evidence that their further increase produces clinical benefit. Vasodilators are obviously contraindicated if systemic arterial pressure is low. If the failure cannot be controlled, embolisation of the lesion should be considered. The goal of this paper is to provide a rational approach to the treatment of circulatory failure due to cerebral arteriovenous shunts.
Interventional Neuroradiology in Thailand: 1989–1997
Authors: Suthipongchai S. , Pongpech S. , Siriwimonmas S. , Chawalparit O. , Churojana A. , Chiewvit P. 
Published: January 2017

In 1979 the Siriraj team in Bangkok began exploring a field that was then new in Thailand, i. e. interventional neuroradiology. This first phase consisted mostly in self-training and foreign exposure. It included experimental work with animal models, as well as early clinical trials designed to assess our skills in particle embolisation and the ligated and detachable balloon techniques. In 1990 a new phase started. Essential techniques were acquired in collaboration with the neurovascular unit of Bicêtre Hospital in France during a three year training programme. Throughout this period, the support of the Association Médicale Franco-Asiatique (AMFA) and the French foreign affairs department proved vital. Our department progressively became a referral centre for the different techniques used in embolisation (balloons, glue…) and for various vascular lesions of the brain, the head and neck region, and spinal cord diseases. Within Mahidol University, the Ramathibodi and Prasat Hospital centres started the same interventional neuroradiology training program in 1995; they benefited from the same tutors and connections as Siriraj. In 1996, the newly acquired biplane DSA machines in both centres enabled us to improve the treatment of arteriovenous malformations - using the glue technique –, intracranial aneurysm - using GDC-coils -, clot lysis, angioplasty… etc. According to international recommendations, the critical mass we reached in 1997 in terms of number of patients and interventions, allows us to offer training in endovascular techniques to junior neuroradiologists at Mahidol university.