bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endovascular Treatment: Part Two
Authors: Bergui M. , Stura G. , Bradač G.B. 
Published: April 2015

The aim of this study is to consider the results of the aneurysms treated in our unit in the last years. The results of a given treatment are very difficult to evaluate if a series of prior assumptions have not been made, i.e., the goals of treatment, patient selection, and so on. This is particularly true if alternative treatments are available and if, as in the present work, the cases are recruited over a relatively long time with respect to the time of evolution of the technique. Two techniques were used, occlusion of the parent vessel with secondary thrombosis of the aneurysm and selective occlusion of the aneurysm with coils.
Intensive Care for Patients with Subarachnoid Haemorrhage
Authors: Berardino M. , Sciacca P.F. 
Published: April 2015

The intensive care treatment in patients with subarachnoid haemorrhage (SAH) is aimed at maintenance of adequate cerebral perfusion and oxygenation. SAH is charged in 40% of cases with at least one life-threatening event and 20 to 30% of deaths are related to extracerebral complications. So the main task in Neurointensive Care is to keep the physiological parameters under control. That is why we need accurate monitoring. Currently used systemic and cerebral monitoring is thus presented. Even basic cardiovascular monitoring (ECG, blood pressure, pulse oxymetry, central venous pressure, urine output) need a great workload in managing the quality of signals and raw data. SAH is often associated with cardiovascular impairment; haemodynamic monitoring is then necessary to graduate hynotropic (stroke volume, cardiac index, systemic and pulmonary resistances) and volemic support (central venous pressure, wedge pressure): a Swan-Ganz catheter is then indicated. Then ventilation is considered: non only a “cerebral” oriented ventilation but a strategy aimed at pulmonary protection too. The ultimate result of ventilation is still adequate oxygenation and acid-base balance that are to be verified. Cerebral monitoring is then resumed starting from cerebral perfusion pressure. The O2 delivery is monitored by a global estimation like jugular venous oxygen saturation, that has a low sensitivity in SAH patients, and by tissue O2 tension which measure O2 delivered near the injured area. Lastly, Transcranial Doppler Monitoring is presented with its limits and indications. Three clinical examples are presented on a multimodal approach in TCD, PtO2 and cerebral perfusion pressure monitoring.
Clinical Validity of the MoSeSS RARE-Sequence at CSF Flow Disturbances
Authors: Orszagh M. , Büchert M. , Schulte D. M. , Krauss J. K. , Schumacher M. , Hennig J. 
Published: April 2015

The development of non-invasive diagnostic methods is a matter of great importance. This paper describes Motion Sensitized Single Shot RARE Sequences (MoSeSS) as a new, non-invasive diagnostic method in CSF-flow disturbances. The range of applications and clinical validity are examined. The strongly T2-weighted RARE-sequence displays selectively unbound water. The addition of flowencoding gradients shows moving spins flow-dependently as a signal reduction. ECG-triggering enablesthe registration of present flow phases, and the CSF-flow can be observed as cine-mode in quasi real-time. Thirty healthy subjects and 137 patients from subcollectives with diverse CSF-flow disturbances were investigated. The MoSeSS RARE-sequence provides reliable information in occlusion or stenoses of the inner CSF-spaces and in ventriculocisternostomies. Indirect signs of shunt dysfunction are CSF turbulences which correlate in degree with the increase in CSF pressure. Determination of localization and degree of dural impairment in traumatic or postoperative pseudomeningoceles is dependent on the activity of the CSF-flow at the leak. Depending on the stage of NPH, a variably marked active flow oscillation in the aqueduct and in the third ventricle is shown. Liquorrhoea has no definable flow detectable with the MoSeSS RARE-sequence. Vascular pulsation can make differentiation of the CSF-flow from artefacts difficult near larger vessels. The MoSeSS-RARE-Sequence is a fast, non-invasive and radiation-free method, which yields valid clinical information on circulation disturbances in the inner CSF-spaces. With the cine-mode technique, CSF movements can be observed in quasi real-time. Positive enhancement of the CSF is necessary in assessing processes with an undefined, non-detectable flow.
Parietal Arteriovenous Malformation Associated with Ipsilateral Persistent Primitive Hypoglossal Artery
Authors: Mori H. , Abe O. , Maruyama K. , Shin M. , Tago M. , Masumoto T. , Yoshikawa T. , Yamada H. , Hayashi N. , Aoki S. , Ohtomo K. 
Published: April 2015

We describe a patient with a rare association of a parietal arteriovenous malformation (AVM) and an ipsilateral persistent primitive hypoglossal artery (PPHA). A 27-year-old woman was treated by surgical removal, followed by gamma-knife radiosurgery. Only seven cases of intracranial AVM associated with PPHA have been reported in the literature. Although AVM associated with persistent carotid-basilar anastomosis has no distinguishing features compared with ordinary AVM, early recognition of the association is of significance to minimize neurological deficits during diagnostic angiography, interventional radiology (embolization) and surgery. The present report adds to the growing literature regarding AVMs associated with carotid-basilar anastomoses.
Carotid Eversion Endarterectomy
Authors: Dall'Antonia F. 
Published: April 2015

Carotid eversion endarterectomy is a long-standing vascular surgery technique practised at the San Bortolo Hospital. We compared this technique with more traditional surgical methods, summarising patient outcome in the tables. Eversion endarterectomy offers many advantages over traditional surgical techniques and must now be compared with interventional radiology procedures.
Substrati anatomo-patologici degli aneurismi cerebrali
Authors: Angelini A. , Abdurahakman A. , Manara R. , Amistà P. , Thiene G. 
Published: April 2015

Atherosclerosis and fibromuscular dysplasia are the two most common causes of cerebral aneurysms. Saccular aneurysms are mainly congential and located in the bifurcations. Fusiform aneurysms are caused by atherosclerosis and involve the posterior portion, mainly the vertebral and basilar arteries and may develop into giant aneurysms. Cerebral atherosclerosis causes two types of lesions: stenosis with the formation of atheromatous plaque jutting into the lumen, and aneurysms leading to vascular remodelling with erosion of the internal elastic membrane, atrophy of the media and thickening and hyalinization of the intima. Atheromatous plaque is characterised by a fibromuscular intimal cap and a necrotic lipid core with atrophy of the underlying media. Plaque may thicken to occlude the vessel by intraplaque haemorrhage and superimposed occlusive thrombosis due to ulceration, or rupture of the fibrous cap caused by inflammation. It remains unsettled whether atherosclerotic cerebral aneurysms are malformations, with congenital abnormalities of the internal elastic membrane and elastic fibres constituting the media, or whether atheromatous changes are secondary to impaired blood flow. Thinning of the wall could also be caused by flow changes with parietal stress resulting from the turbulence caused by atherosclerotic stenotic lesions or the outcome of dissection of the arterial wall. Fibromuscular dysplasia is a multifocal vascular disease of unknown origin, not atherosclerotic or inflammatory, mainly affecting the brain media with lesions characterized by areas of concentric fibromuscular tissue jutting into the vessel lumen alternating with areas of thinning to almost disappearance of the tunica media and discontinuity of the internal elastic membrane in areas of thinning with the formation of aneurysms. Vessel calibre varies with areas of luminal stenosis alternating with areas of aneurysmal dilatation. The origin of this disease remains unknown and it is thought to be multifactorial possibly associated with saccular aneurysms, fusiform giant aneurysms, dissection of the intracranial arteries, cavernous fistulae and stenosis or occlusion associated with dysplasia. Aneurysms in the brain may share the same underlying mechanisms as aneurysms elsewhere involving atherosclerosis and fibromuscular dyspasia, i.e. remodelling of the extracellular matrix. A recent hypothesis suggested that cerebral aneurysms were caused by an active mechanisms in the arterial wall rather than a passive process linked to genetically determined structural defects or purely haemodynamic events. Apoptosis has also been implicated in the remodelling of the extracelular matrix in the wall of cerebral aneurysms.
Terapia chirurgica degli aneurismi cerebrali
Authors: Scienza R. , Pavesi G. 
Published: April 2015

Cerebrovascular disease continues to be a major source of morbidity and mortality in our aging population. Cerebrovascular disease continues to present challenges in the diagnostic and therapeutic arena. Prevention and treatment of stroke represent an unconquered frontier in clinical neuroscience. The ability to identify and treat cerebrovascular abnormalities before permanent ischemic deficit occurs is rapidly increasing. Endovascular therapy of vascular malformations and vasospasm are today a necessary comparison with microsurgery; cerebral blood flow measurements tool give clinicians the opportunity to identify patients at risk for ischemic damage and to suggest new therapeutic paths; minimally invasive diagnostic tools are gradually reducing the indication for cerebral angiography. Such major advances in technology, that are actually changing our therapeutic approach to cerebrovascular disease, and to cerebral aneurysms treatment, will soon result in safer more effective treatments, minimizing the onset of permanent neurologic deficits. Anyway, it is a fact that the majority of cerebral aneurysms are still treated by microsurgery, either because of the wider diffusion of specialized centers offering this technique, or because of the longer follow up on the obtained results achieved by neurosurgeons. The object of the present study is to show how the surgical treatment of cerebral aneurysms is organized, and which are the main problems that neurosurgeons are facing in the effort to conjugate microsurgical treatment with the new ancillary technologies for the study of cerebrovascular malformations.
Aneurismi intracranici problematici Chirurgia e terapia endovascolare a confronto
Authors: Skrap M. , Vindigni M. , Janes P.P. , Petralia B. 
Published: April 2015

The surgical technique used for cerebral aneurysms is still considered a delicate procedure but surgeons' skill yields excellent results in the majority of regular aneurysms. Moreover, the endovascular treatment with detachable coils has become a routine procedure and at present the discussion about the best indication for treating the aneurysms is lively. We present our series of 361 aneurysms treated in six years with 267 surgical procedures and 94 endovascular treatments. The indication for endovascular treatment in our Department is usually put for aneurysms of the basilar trunk, basilar bifurcation, infraclionid tract of the Internal Carotid artery, in patients with higher H&H grade (3–4) and in older patients with poor general condition. The global mortality of endovascular cases was 21% while in the surgical series the global mortality was 15%. We must consider that 60% of endovascular cases were in grade 3–4 of Hunt&Hess while in the surgical series only 40% were in the same situation. Only 2.7% of the cases (10 patients) were a really difficult problem for each separate technique. In these cases a combination of surgical and endovascular procedure was adopted and in only five cases was it possible to treat the aneurysms properly. In our opinion, a combined approach can be useful only in some selected cases but we should take into account the fact that nowadays surgery has reached the upper limits of its technique while, on the contrary, the endovascular technology is still in progress.
Il trattamento endovascolare degli aneurismi giganti
Authors: Sirabella G. , Saponiero R. , Esposito F. , Napoli A.N. , Siani A. , Locatelli G.P. 
Published: April 2015

We describe giant aneurysms (> 25 mm in diameter) discussing endovascular techniques and reporting the outcome of treated cases. The endovascular technique to be adopted must be chosen after careful morphologic analysis of the aneurysm. Currently, the best solution is probably occlusion of the parent vessel thereby eliminating the mass effect and excluding the aneurysm from flow.
Diffusion-Weighted and Diffusion Tensor Magnetic Resonance Brain Imaging: Principles and Applications
Authors: Pizzini F. , Beltramello A. , Piovan E. , Alessandrini F. 
Published: April 2015

Diffusion Weighted Imaging (DWI) is one of the most recent products of Magnetic Resonance (MR) technology evolution. DWI has been proposed as a noninvasive tool for evaluating structural and physiologic states in biologic tissues as hyperacute ischemic changes within brain tissue. Recently, its more complex and detailed evolution, Diffusion Tensor Imaging (DTI), has been introduced and its clinical applications are the evaluation of anatomical structures and pathologic processes in white matter. White matter quantitative maps that indicate the integrity of brain tissue, color map, and tractography that identifies macroscopic three-dimensional architecture of fiber tracts (e.g., projections and association pathways) can be obtained with DTI. Diffusion weighted imaging visualization techniques (ADC and Trace) are applied for the study of stroke, in the differential diagnosis of expansive lesions (e.g. epidermoid vs. arachnoid cyst) and in detecting traumatic and other lesions associated with restricted diffusion (e.g. MS plaques). On the other hand, DTI provides the identification of abnormalities in the otherwise normal appearing white matter with the understanding of the organization of the fibers, both in tumors and in other cortical or white matter diseases (including stroke, dementias, demyelinating-dismyelinating diseases, epilepsy, schizophrenia). Furthermore, in combination with functional MR, DTI might contribute to the comprehension of brain development, aging and connectivity, thus having a significant impact on brain functional studies.
Sinovenous Thrombosis in Newborn
Authors: Ferrari E. , Doni D. , De Grandi C. , Paterlini G. , Viganò E. , Tagliabue P. 
Published: April 2015

We present a case of cerebral thrombosis in a newborn with no apparent risk factors but who further investigations proved to have Protein C deficiency. Symptoms of presentation were seizures; the diagnosis was made by Magnetic Resonance Imaging (MRI) and angioMRI; a thrombolytic therapy with recombinant tissue plasminogen activator (rTPA) followed by a prophylaxis with low molecular weight heparin (LMWH) were successfully implemented. Given the advances in imaging techniques (Power Doppler examination via the mastoid approach), cerebral ultrasound allowed us to suspect thrombosis, to monitor treatment efficacy and to confirm complete resolution, in this case.
Un raro caso di vitreo iperplastico primitivo persistente bilaterale (VPIP)
Authors: Puglielli E. , Splendiani A. , Polito M. , Blasi M.A. , Masciocchi C. , Gallucci M. 
Published: April 2015

We describe the magnetic resonance features of a rare case of bilateral persistent primitive vitreous. After an initial MR scan, a follow-up investigation disclosed a stationary picture. Thanks to its multiplanar features, MR allowed the correct identification and characterization of the malformation together with its associated endobulbar changes. The exceptional presence of a bilateral lesion, described in very few literature reports, makes the diagnosis difficult on a clinical basis. Current neuroradiological techniques offer crucial diagnostic support and allow differential diagnosis. Technical know-how and a knowledge of the symptoms of this disease are essential.
Problematiche e contributi nella presa in carico dei pazienti affetti da Sclerosi Tuberosa
Authors: Veneselli E. , Di Comite R. 
Published: April 2015

Tuberous Sclerosis Complex (TCS) is a multisystem autosomal dominant disorder, with high spontaneous mutation rate; it is charactherized by very different clinical phenotypes and widespread development of hamartias, or non-growing lesions, and hamartomas, wich can grow as benign tumors and rarely progress to malignances. We reported the TSC Consensus Conference Diagnostic Criteria, divided into major and minor features (1998), and Recommendations for diagnostic evaluation (1999). Since the age-dipendent appearance and the frequency of symptoms, their usefulness is limited in pediatric patients. Then we examined the data about the incidence of clinical features from infancy into childhood, with the aim of improving the diagnostic evaluation and the follow up of pediatric patients. Therefore, also on the basis of the personal experience, we stressed the opportunity of a flexible clinical approach and the existence of some features stimulating other clinical and basic research studies.
Effetti secondari comparati dei mezzi di contrasto ionici e non ionici
Authors: Del Favero C. 
Published: April 2015

Vengono presentati i risultati relativi alle reazioni avverse dei mezzi di contrasto ionici e non ionici introdotti per via venosa in 34.928 pazienti. L'incidenza delle reazioni avverse è stata dell '11.47% con il mezzo di contrasto ionico e 2.1% con il mezzo di contrasto non ionico. Si è notato un incremento di rischio per i soggetti con anamnesi allergica. Le reazioni avverse sono state prevalentemente minori e moderate mentre le gravi sono state più frequenti con il mezzo di contrasto ionico. Complessivamente i mezzi di contrasto non ionici diminuiscono l'incidenza delle reazioni avverse da 1 a 5–8 volte rispetto ai contrasti ionici.
Il mezzo di contrasto per via venosa nello studio TC dell'encefalo
Authors: Andreula C.F. 
Published: April 2015

L'uso del mezzo di contrasto per via venosa nella TC dell'encefalo svolge un ruolo chiave nell'incremento di sensibilità della metodica, ma vieppiù immette altri dati nel raggiungimento di una diagnosi di specificità. L'autore riporta e discute le concentrazioni, le dosi riguardanti il mezzo di contrasto, sottolineando la necessità di uso di mezzi di contrasto a bassa osmolarità per la minore incidenza di effetti indesiderati, con predilezione per i non ionici. Le tecniche di somministrazione più utilizzate sono la bifasica la metodica del bolo rapido e le tecniche speciali con doppia dose di contrasto e scansioni ritardate. I reperti TC sono stati distinti utilizzando come parametro di valutazione la barriera ematoencefalica, importante struttura anatomo funzionale, la cui integrità, assenza, danneggiamento o malfunzionamento determinano rilievi tomodensitometrici di contrast-enhancement (CE) importanti per una diagnosi di specificità. L'autore inoltre sottolinea l'importanza della valutazione della dinamica del CE e delle curve densità/tempo, utilizzando la tecnica speciale di doppia dose e scansioni ritardate, discutendone i rapporti con le sequenze di impulsi in Risonanza Magnetica.
Impiego dei mezzi di contrasto per via subaracnoidea in Tomografia Computerizzata
Authors: Cirillo S. , Simonetti L. , Di Salle F. , Lopez A. , Elefante R. , Smaltino F. 
Published: April 2015

L'iniezione di mezzo di contrasto per via intratecale in corso di Tomografia Computerizzata, è stata usata per vari anni, a livello dei distretti vertebro-midollare e cranio-encefalico per migliorare la definizione anatomica e per avere informazioni sulla dinamica liquorale. L'avvento degli apparecchi per Tomografia Computerizzata «ad alta risoluzione» e, negli ultimi anni, della Tomografia a Risonanza Magnetica, richiede una revisione delle indicazioni attuali e della validità di questa metodica.
L'angiografia cerebrale in età pediatrica
Authors: Scotti G. , Pieralli S. , Righi C. , Triulzi F. , Visciani A. 
Published: April 2015

All'angiografia non si richiedono oggi tanto informazioni indispensabili per giungere alla diagnosi, che sono quasi sempre ottenibili con le tecniche non invasive, quanto una dimostrazione accurata e completa dei vasi e della patologia che primitivamente li interessa, ed eventualmente delle caratteristiche di vascolarizzazione di neoplasie o lesioni espansive in genere. L'angiografia in età pediatrica conserva, anche se ridotte di numero, molte indicazioni anche nell'epoca del massimo sviluppo della Tomografia Computerizzata (TC), della Risonanza Magnetica (RM) e della ecografia.
La diagnostica angiografica dell'ictus cerebrale
Authors: Bradaê G.B. 
Published: April 2015

La conoscenza di tutti gli aspetti fisiopatogenetici dell'ischemia cerebrale, che sono molteplici, è l'indispensabile presupposto sia per porre l'indicazione ad uno studio angiografico, sia per interpretare correttamente sulla base degli angiogrammi il meccanismo patogenetico probabile dell'ischemia. L'autore tratta della diagnostica angiografica prendendo in considerazione tre momenti fondamentali dell'iter diagnostico: 1, l'indicazione all'angiografia; 2, la tecnica angiografica; 3, gli aspetti angiografici.
Studio anatomico RM del sistema nervoso centrale
Authors: Colombo N. , Scialfa G. 
Published: April 2015

La Risonanza Magnetica (R.M.) è la metodica diagnostica che attualmente fornisce la migliore rappresentazione dell'anatomia morfologica e funzionale del Sistema Nervoso Centrale (SNC). L'alta risoluzione di contrasto e spaziale della metodica, e la possibilità di acquisire immagini dirette nei tre principali piani anatomici (assiale, sagittale e coronale), sono tra i vantaggi che sanciscono la sua superiorità rispetto ad altre modalità di imaging. Le immagini «pesate in T1» sono le più idonee per uno studio morfologico-macroscopico delle varie strutture del nevrasse, mentre le immagini «pesate in T2» meglio delineano strutture intrinseche al SNC (fasci di sostanza bianca, nuclei grigi centrali).
La Risonanza Magnetica in età pediatrica
Authors: Elefante R. , Cirillo S. , Simonetti L. , Tessa G. La , Smaltino F. 
Published: April 2015

La Risonanza Magnetica (RM) ha trovato un campo di applicazione ideale nello studio neuroradiologico della patologia del Sistema Nervoso Centrale in età pediatrica. Essa, infatti, presenta potenzialmente chiari vantaggi rispetto alle altre tecniche disponibili, prima tra tutte la Tomografia Computerizzata. Questi vantaggi sono rappresentati dalla assenza di invasività radiobiologica e farmacologica e dalla alta efficacia diagnostica nella maggior parte dei capitoli della patologia neurologica del bambino. Nella sua applicazione in età pediatrica la RM presenta anche alcuni problemi. Si tratta principalmente dello scadimento della qualità di immagine per la necessità di usare scansioni sottili e campi di vista ridotti, della necessità di procedere, nei bambini più piccoli alla narcosi e della difficile accessibilità dell'esame. Risolti tali problemi, la RM si propone quale metodica di prima scelta in neuroradiologia pediatrica.