摘要:

OBJECTIVETo test the concept that endovascular angioscopy can assist surgical intracranial aneurysm clipping by providing an endoluminal view of the aneurysm-parent vessel complex.METHODSA carotid bifurcation aneurysm was surgically created in a dog at the lingual artery origin. A balloon catheter was inflated proximal to the aneurysm to block proximal blood flow and allow endoluminal visualization. A flexible angioscope connected to a video monitoring system and to a high-intensity light source was then advanced within the catheter lumen and positioned immediately distal to the catheter tip. The aneurysm neck was clipped, and the clip was repositioned several times along the neck, with or without distal parent vessel compromise. Each time, the endovascular image on the monitor was interpreted by an observer blinded to the position of the clip. Clip position and image interpretation were communicated independently to a third person, who analyzed the correlation between them.RESULTSAngioscopy allowed clear visualization of the extent of aneurysm neck occlusion (complete, incomplete, residual “dog ear”) after clip application, as well as the presence or absence of distal parent vessel compromise. Aneurysm neck configuration, size, presence of thrombus, and suture line definition were depicted. Critical structures external to the aneurysm-parent vessel complex were transilluminated by the high-intensity lamp.CONCLUSIONAlthough acknowledged as the treatment of choice for intracranial aneurysms, surgical exclusion can be accompanied by significant morbidity related to perforator occlusion, parent artery compromise, and/or persistent residual aneurysm. The availability of a device allowing visualization of an aneurysm from an endoluminal perspective theoretically could reduce the incidence of these complications. Angioscopy has the potential to become a useful adjunct during intracranial aneurysm clipping because it provides real-time endoluminal viewing of the aneurysm-distal parent vessel complex, which is sometimes obscured to the surgeon.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVEIt is well known that nucleus pulposus induces nerve root injury. The aim of this study was to assess the relationship between intraneural blood flow and motor nerve conduction velocity (NCV) after incision of the adjacent disc.METHODSA total of 65 dogs were used. A left hemilaminotomy was performed, the annulus fibrosus of the L6–L7 intervertebral disc was incised, and nucleus pulposus was gently pushed into the epidural space by saline solution injection. A left hemilaminotomy without disc incision was used as the sham operation. Seven dogs were used for incision and five dogs for sham treatment for each of the following time points: 1 day, 3 days, 1 week, 1 month, and 2 months of exposure. Five additional dogs were used to establish baseline data. Blood flow in the nerve root was measured in the left L7 nerve root with a tissue blood flowmeter, using an electrolytic hydrogen clearance method. Motor NCV over the exposed area of the nerve root was measured using a neurophysiological technique.RESULTSThere was a reduction in blood flow in the nerve root after disc incision that began after 1 day and was maximal after 1 week. This reduction had resolved by 1 month, however. The motor NCV showed a reduction pattern similar to that for blood flow in the nerve root, but reduction did not begin until 3 days after disc incision and was not fully resolved until 2 months.CONCLUSIONThis study demonstrates that the reduction and recovery of motor NCV are related to, and preceded by, a reduction in blood flow in the nerve root. The data might provide important information regarding the basic pathophysiological mechanisms of nucleus pulposus-induced nerve root injury.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE AND IMPORTANCEVertex epidural hematomas may be underestimated or overlooked altogether when computed tomographic scans alone are used for diagnosis. Such hematomas can be resolved with active intervention and sometimes with conservative treatment.CLINICAL PRESENTATIONTwo cases of successfully treated vertex epidural hematomas, in a 33-year-old man who presented with seizures and an 11-year-old girl who presented with headache and vomiting, are described. Both hematomas were traumatic in origin and were associated with cranial fractures. In each, coronal images (computed tomographic or magnetic resonance imaging scans) showed the extent of the hematoma much more clearly than did axial images.INTERVENTIONOne case was treated surgically and the other conservatively.CONCLUSIONMagnetic resonance imaging is not usually indicated for trauma patients, but it is an appropriate diagnostic modality for these rare lesions, to supplement standard axial computed tomographic scans. Because vertex epidural hematomas may resolve spontaneously with time, conservative treatment should be considered on a case-by-case basis.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE AND IMPORTANCECerebral venous and dural sinus thrombosis is a rare cause of stroke. Although morbidity and mortality have greatly decreased in recent years as a result of early diagnosis and timely medical treatment, when coma occurs the prognosis remains poor. We evaluated whether emergent decompressive craniectomy has a role in the treatment of patients with brain herniation from dural sinus thrombosis and hemorrhagic infarct.CLINICAL PRESENTATIONThree patients developed large hemorrhagic infarct with coma and bilaterally fixed and dilated pupils resulting from aseptic dural sinus thrombosis.INTERVENTIONTwo patients underwent emergent surgical decompression as soon as brain herniation developed, and these patients had complete functional recovery. One underwent delayed surgical decompression and remained severely disabled.CONCLUSIONOur results provide preliminary evidence that emergent decompressive craniectomy is effective in patients with brain herniation from dural sinus thrombosis, provided that the clinical onset is recent. We therefore recommend consideration of this aggressive surgical technique for such patients, who may survive with good outcomes.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE AND IMPORTANCEOculomotor schwannoma is extremely rare. We report a case of oculomotor schwannoma with consideration of its surgical management.CLINICAL PRESENTATIONA 64-year-old woman with a history of chronic headache underwent a computed tomographic scan, which revealed a mass lesion in the right prepontine cistern. She had no neurological deficits at admission.INTERVENTIONThe tumor originated from the right oculomotor nerve. It was subtotally removed, leaving a tiny part attached to the nerve. The nerve trunk was preserved. A pathological examination revealed a schwannoma. Transient right oculomotor nerve palsy occurred postoperatively, but it improved almost completely.CONCLUSIONThe tumor in the present case was resected, preserving serviceable oculomotor function. However, among 16 patients reported in the literature, all but one developed or maintained severe postsurgical oculomotor nerve palsy. We conclude that surgical resection generally is not indicated for oculomotor schwannomas, excluding large tumors that cause intractable symptoms.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE AND IMPORTANCEThe vasa vasorum are involved in the pathophysiological development of carotid artery atherosclerosis, providing vascular support to the thickened intima and plaque. When advanced atherosclerosis causes carotid artery occlusion, the vasa vasorum may serve as a means of revascularization.CLINICAL PRESENTATIONWe studied four patients with internal carotid artery occlusion who exhibited revascularization, distal to the occlusion, by small vascular channels that were inconsistent with recanalization through the thrombus. The channels had an angiographic appearance consistent with their being hypertrophied vasa vasorum. Significant collateral circulation was provided by the revascularization.INTERVENTIONAll four patients exhibited adequate collateral circulation and were treated with antiplatelet or anticoagulation medication.CONCLUSIONThe vasa vasorum have not been previously reported to contribute to the revascularization of occluded arteries. The four cases presented in this report suggest that the vasa vasorum can be a source of collateral circulation after carotid artery occlusion secondary to atherosclerotic disease.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE AND IMPORTANCEAtherosclerotic occlusive disease of the intracranial vasculature is associated with increased risk of systemic vascular occlusive disease and stroke. Therapeutic options have included anticoagulation therapy, antiplatelet therapy, or, in a limited number of patients, extracranial-intracranial vascular bypass procedures. We report a patient who had improved cerebral perfusion with silent watershed zone infarctions after endovascular stenting of a severe petrous segment carotid stenosis.CLINICAL PRESENTATIONA 73-year-old man with severe coronary artery disease and unstable angina was referred for treatment of a 90% right petrous carotid artery stenosis before coronary artery bypass grafting. A brain single-photon emission computed tomographic scan using99mTc-bicisate revealed diminished perfusion throughout the right internal carotid artery territory, particularly in posterior watershed zones.TECHNIQUEThe patient underwent transfemoral placement of a 7-French introducer sheath, followed by a 7-French guide catheter. Urokinase (225,000 U) was infused through a microcatheter placed proximal to the lesion. No changes were noted in lesion morphology after this infusion. A microguidewire was navigated across the lesion. Subsequent balloon angioplasty with a coronary artery balloon was performed twice, followed by placement of a 4- × 12-mm coronary stent.CONCLUSIONSelective internal carotid artery angiography after stenting revealed markedly improved flow. A brain99mTc-bicisate single-photon emission computed tomographic scan performed within 24 hours of stent placement, revealed significantly improved perfusion within the right internal carotid artery territory. Two perfusion voids suggestive of embolic stroke were noted; both were clinically silent. The patient had uncomplicated coronary artery bypass grafting 72 hours later. Five months postoperatively, he remains at home, living independently and with intact neurological function. Intracranial stenting for severe atherosclerotic stenosis is technically possible. However, its ultimate clinical role remains to be determined.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID